AB1011 COMPREHENSIVE DISEASE CONTROL IN SYSTEMIC LUPUS ERYTHEMATOSUS: WHEN REMISSION GOES HAND IN HAND WITH THE CONTROL OF CHRONIC DAMAGE
Authors: F. Ceccarelli, C. Ciancarella, F. Natalucci, L. Picciariello, C. Garufi, S. Mancuso, S. Truglia, F. R. Spinelli, C. Alessandri, F. Conti
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The achievement of remission represents a relevant goal in the management of Systemic Lupus Erythematosus (SLE). The beneficial effect of this condition on the prevention of chronic damage has been clearly demonstrated. However, the damage is a multifactorial phenomenon: indeed, besides disease activity, other factors could contribute to its development, including treatment (in particular glucocorticoids - GCs). This evidence suggests the possible progression of damage despite the control of disease activity. Into this scenario fits the concept of Comprehensive Disease Control in SLE (LupusCDC), which underlines as the achievement of remission must go along with the damage control. Indeed, the definition of remission in SLE substantially changed in the last years, emphasizing the need for a broader definition including not only disease activity, but also treatments considered acceptable in a remission status. Hence the definition proposed by the DORIS group, according to which a patient is defined as being in remission in the presence of (i) clinical SLEDAI-2k=0, (ii) PGA&lt;0.5, (iii) PDN≤5mg/daily, (iv) stable immunosuppressant treatment. <h3>Objectives:</h3> In the present cross-sectional study we analysed a monocentric SLE cohort to assess the prevalence of LupusCDC, defined for the presence of remission according to DORIS definition and the lack of progression in damage, as assessed by SLICC Damage Index (SDI). <h3>Methods:</h3> We evaluated consecutive SLE patients (2019 ACR/EULAR classification criteria). Clinical and laboratory data were collected in a standardized computerized electronically filled form including demographics, past medical history, comorbidities, treatments. Indeed, we evaluated the presence of remission according to DORIS definition; furthermore, SDI was calculated at the time of the enrolment and in the visit performed 12 months before to assess the damage progression. Finally, we evaluated the prevalence of LupusCDC condition, defined for the achievement of remission plus the absence of damage progression. <h3>Results:</h3> We evaluated 273 patients [M/F 18/255; median age 49 years (IQR 17); median disease duration 14 years (IQR 14.5). A status of DORIS remission was found in 178 patients (65.2%). Patients achieving remission showed a longer disease duration (p=0.005), and a significantly lower prevalence of acute skin manifestations (p=0.02), proteinuria &gt;0.5g/24h (p=0.03) and lower C3/C4 levels (p=0.003), the latter confirmed at logistic regression (p=0.01; OR=1.9; 95%CI 1.1-3.2). Interestingly, 41 patients (15.0%) did not achieve remission due to the lack of one criterion, represented in most cases by the PGA&lt;0.5 (39.0%), followed by clinical SLEDAI=0 (34.1%). Moving on damage, SDI&gt;0 was found in 147 patients (53.8%; mean土SD 1.03土1.34); the presence of damage was significantly associated with age (p&lt;0.001), disease duration (p&lt;0.001), GCs treatment (p=0.009), hypertension (p&lt;0.0001), hyperuricemia (p&lt;0.0001), concomitant antiphospholipid syndrome (p=0.04). The comparison with the assessment performed 12 months before demonstrated the increase of SDI values in 27 subjects (9.9%). This progression was significantly associated with age (p=0.01). A condition of LupusCDC was found in 164 patients (60.1%, Figure 1). The lack of achieving LupusCDC was significantly associated with low levels of C3/C4 (p=0.03), proteinuria &gt;0.5g/24h (p=0.006), oral ulcers (p=0.009), acute skin lupus (p=0.01), serositis (p=0.03). Logistic regression confirmed the association between serositis and lack of LupusCDC achievement (p=0.02, OR=0.36, CI95% 0.14-0.883). <h3>Conclusion:</h3> The results of the present study demonstrated that a condition of comprehensive disease control is an achievable goal even in a heterogeneous disease such as SLE. By including DORIS definition, the outcome proposed in this study encompasses disease activity, acceptable treatment, and chronic damage, providing an all-around evaluation of SLE patients. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>