Clinical characteristics of systemic lupus erythematosus patients in long-term remission without treatment

• Published in: Clinical rheumatology Vol. 39; no. 11; pp. 3365 - 3371
• Main Authors: Jakez-Ocampo, J., Rodriguez-Armida, M., Fragoso-Loyo, H., Lima, G., Llorente, L., Atisha-Fregoso, Y.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.11.2020; Springer Nature B.V
• Subjects: Aged; Antigenic characteristics; Cohort Studies; Humans; Immunoglobulin G; Lupus; Lupus Erythematosus, Systemic - drug therapy; Medicine; Medicine & Public Health; Original Article; Patients; Phenotypes; Remission; Remission (Medicine); Remission Induction; Retrospective Studies; Rheumatology; Risk factors; Serology; Severity of Illness Index; Systemic lupus erythematosus; Thrombocytopenia; Thromboembolism; Remission; Disease activity; Systemic lupus erythematosus; Treatment
• ISSN: 0770-3198; 1434-9949
• DOI: 10.1007/s10067-020-05379-8

Objective To describe the clinical and serological characteristics of patients with SLE who reached a state of sustained remission for more than 10 years in the absence of treatment. Methods From a retrospective cohort of 2121 patients, 44 cases with sustained remission (PtRem) were identified and compared with 88 patients whose course has been chronically active (PtAct).The clinical and serological characteristics were analyzed, as well as the treatment of each group at the beginning of the disease and during its evolution. Results Older age at disease onset was associated with a tendency to reach a state of prolonged remission. These patients also had a higher frequency of thrombocytopenia at the beginning of the disease 34.1% vs 10.2% ( p  < 0.001). PtAct had a significantly higher initial SLEDAI compared with cases (10.4 ± 5.6 vs 14.1 ± 5.8; p  < 0.001). PtRem had a higher initial frequency of anti-β2 GP1 IgG antibodies. Also, 25% of these patients were serologically active. We did not find differences in the initial treatment between both groups. The accumulated damage measured by SLICC/ACR damage index at the end of the study was significantly less in the patients who remained in prolonged remission. Conclusions Although patients with SLE who achieve prolonged remission have some different characteristics at baseline compared with PtAct, it is not possible to identify a characteristic phenotype for the former. Achieving a state of prolonged remission should always be the goal in patients with SLE. Key Points • SLE patients can reach a very prolonged state of remission, free of treatment, including antimalarials, for at least 10 years. • Venous thromboembolism and thrombocytopenia are commonly present in patients that achieved remission. • The presence of serological markers of activity, even after 10 years in remission, is a risk factor for relapse.