AB0480 PROLONGED CLINICAL REMISSION AND LOW DISEASE ACTIVITY STATUSES ARE ASSOCIATED WITH BETTER QUALITY OF LIFE IN SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: Nareerat Poomsalood, Sumapa Chaiamnuay, Pongthorn Narongroeknawin, Paijit Asavatanabodee, Rattapol Pakchotanon
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Treat to target (T2T) strategies in systemic lupus erythematosus (SLE) have been developed in order to control disease activity, improve health-related quality of life (HRQoL), reduce organ damage and decrease mortality. Previous studies revealed that both remission and low disease activity (LDA) had comparable damage accrual as well as mortality. However, studies of HRQoL in these two targets are few and there has been no comparative study between them: <h3>Objectives</h3> To determine the association between disease activity status (DAS) and HRQoL in SLE patients. <h3>Methods</h3> SLE patients in out-patient clinic during the previous 12 months were included in the study. Systemic Lupus Erythematosus-specific Quality-of-Life questionnaire (SLEQoL) was measured at the last visit. DAS was determined retrospectively during the previous year. Three categories of DAS were defined: clinical remission (CR): clinical quiescent disease according to Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), prednisolone &lt; 5 mg/day; low disease activity (LDA): SLEDAI-2K (without serological domain) ≤ 2, prednisolone &lt; 7.5 mg/day; and non-optimally controlled status: those who were not in CR/LDA. Immunosuppressive drugs (maintenance dose) and antimalarials were allowed. Both CR and LDA have been maintained for at least 1 year. The association between DAS and HRQoL was assessed by using multiple linear regression analysis adjusting for other covariates. <h3>Results</h3> Of 237 SLE patients (pts), 100 pts (42.2%) achieved prolonged CR, 46 pts (19.4%) achieved prolonged LDA, and 91 pts (38.4%) were not in CR/LDA. Non-CR/LDA pts had significantly higher total SLEQoL score and in all domains compared with CR/LDA pts. No significant difference in SLEQoL domain scores was found between CR and LDA groups. Multivariable analysis revealed that non-CR/LDA was positively associated with SLEQoL score compared with CR/LDA (β 20.02, 95% confidence interval (CI) 6.81-33.23, p &lt; 0.003). Moreover, non-CR/LDA was at a higher risk of impaired QoL (SLEQoL score &gt; 80) compared with CR (hazard ratio (HR) 3.8; 95% CI 1.82-7.95; p &lt; 0.001). However, there was no significant difference between CR and LDA in term of SLEQoL score or impaired QoL. Other factors associated with higher SLEQoL score were damage index (β 10.55, 95% CI 4.63-16.48, p = 0.001) and anemia (β 27.84, 95% CI 8.48-47.19, p = 0.001). <h3>Conclusion</h3> Prolonged CR and LDA are associated with better HRQoL in SLE patients and have a comparable effect. Prolonged CR or optional LDA may be used as the treatment goal of T2T approach in SLE. <h3>References</h3> [1] Tselios K, et al. Clinical remission and low disease activity have comparable outcomes over 10 years in systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2018 Jul 28. [2] Golder V, et al. Association of the lupus low disease activity state (LLDAS) with health-related quality of life in a multinational prospective study. Arthritis Res Ther. 2017 Mar 20;19(1):62. [3] Mok CC, et al. Prevalence of remission and its effect on damage and quality of life in Chinese patients with systemic lupus erythematosus. Ann Rheum Dis. 2017 Aug;76(8):1420-1425. [4] Tsang-A-Sjoe MWP, et al. The relationship between remission and health-related quality of life in a cohort of SLE patients. Rheumatology (Oxford). 2018 Dec 4. <h3>Disclosure of Interests</h3> None declared