FRI0606-HPR REMISSION IN SYSTEMIC LUPUS ERYTHEMATOSUS, WHAT IS THE IMPACT ON ACCUMULATED DAMAGE?
Authors: F. J. Hüttmann, A. L. Barbaglia, L. Gonzalez Lucero, H. R. Sueldo, M. C. Bertolaccini, S. M. Mazza, Y. Soria Curi, M. L. Leguizamón, G. V. Espasa, L. M. Galindo, M. Santana, V. I. Bellomio
Journal: Annals of the Rheumatic Diseases (2020)

Background: The objective of the treatment in rheumatic diseases is to achieved the remission or minimal disease activity of these patients. Previous studies in Systemic Lupus Erythematosus (SLE) showed that reaching remission had a positive impact on the prognosis of the disease. Objectives: To determine the frequency of remission in a cohort of patients with SLE. To evaluate the effect of disease activity on accrual damage. Methods: A retrospective study was carried out from January 2010 to December 2018. Clinical records of patients with SLE (ACR criteria 1982/97) were reviewed considering baseline visit as the first clinical or control visit of 2010. For subsequent visits, data were collected annually until 2018. SLE activity was defined for each visit according to GLADEL´s definition: 1- Remission Without Treatment (RwT): SLEDAI 0, without prednisone or immunosuppressive drugs (IS); 2- Remission on Treatment (RoT): SLEDAI 0, prednisone up to 5mg/day or immunosuppressive drugs in maintenance doses; 3- LDAS (Low Disease Activity Status): SLEDAI ≤ 4, prednisone up to 7.5mg/ ay and/or IS in maintenance doses; 4- Non-Optimal Activity Control (NOC): SLEDAI&gt; 4, prednisone&gt; 7.5 mg/day and/or IS in induction dose. The use of hydroxychloroquine was allowed for all groups. For the analysis, patients who remained in remission (with and without treatment) or LDAS for at least 75% of the follow-up time were grouped and compared with patients who remained active during that same period. Demographic, laboratory, treatment related variables and death were studied. Accrual damage was assessed with SLICC / SDI. Patients with less than two annual visits were excluded. Statistical analysis: descriptive measures, Test T, Mann Whitney, Chi2 Test, Fisher’s exact test, bivariate correlation, logistic regression model with mixed effects. Results: Two hundred eighty-five medical records were reviewed and 100 patients with SLE were included, 89% women, mean age at baseline visit 38.5 ± 12 years old and mean time of disease 9.3 ± 7.3 years. The average SLEDAI and SLICC/SDI baseline scores were 3.7 and 0.8 respectively. The SLICC/ SDI score at last visit was 2.2 and the average SLICC/SDI change (ΔSLICC) compared to baseline visit score was 1.4 ± 1.6. The prevalence of patients who were in remission for at least 75% of the follow-up time was 38% [95% CI 26.6, 45.4]. NOC patients categorized at baseline visit had the highest ΔSLICC (p 0.0001). The ΔSLICC was significantly lower in patients who were at least 75% of the follow-up time in remission (p 0.01) or LDAS (p 0.01) compared to those with NOC. In the Logistic Regression Model, the chance of changing the SLICC/SDI score was 2.9 times higher for the NOC group than for RwT. Conclusion: The frequency of remission in this cohort of patients with SLE was 38%. Worse control of disease activity, was associated with higher accumulated damage. Disclosure of Interests: None declared