Abstract
ObjectiveTo clarify the frequency and outcome of patients with systemic lupus erythematosus (SLE) who achieved the clinical state as serologically active clinically quiescent (SACQ) and to identify factors associated with the flare of disease.MethodsClinical data of patients diagnosed as SLE and followed in Peking University First Hospital from 2009 to 2015 were retrospectively reviewed. Six hundred eighty-two patients who were followed up for more than 6 months were analyzed. SACQ was defined as an at least a 6-month period with persistent serologic activity and without clinical activity and daily dose of prednisone or equivalent were less than 7.5 mg. Serologically quiescent clinically quiescent (SQCQ) patients served as control groups. Data including demographics, initial symptoms, duration to SACQ, treatments before and after SACQ, and characteristics of the patients suffered from flare were analyzed.ResultsAmong the 682 patients, 170 patients were SACQ (24.9%) and 187 patients were SQCQ. SQCQ patients (38.61 ± 15.08 years old) were older at baseline than SACQ patients (38.61 ± 15.08 years vs. 32.09 ± 14.35 years, p < 0.001). Of 170 SACQ patients, 32.9% experienced flare that was significantly higher than 15.5% of SQCQ patients (29/187). Corticosteroids (OR 1.323, 95% CI 1.129 to 1.550; p = 0.001) was an independent risk factor for flare, while antimalarials (OR 0.045, 95% CI 0.004 to 0.474; p = 0.010) and immunosuppressants (OR 0.332, 95% CI 0.156 to 0.706; p = 0.004) were protective factors in SACQ patients; however, only antimalarials was protective factors in SQCQ patients (OR 0.028, 95% CI 0.001 to 0.743; p = 0.033).ConclusionAbout one third of SLE patients with SACQ experience flare, significantly more frequent than that of patients with SQCQ. Thus, approach to prevent flare in SACQ patient is required. Maintenance therapy of hydroxychloroquine and immunosuppressant agents may be protective and beneficial treatment strategy in these patients.
Highlights
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem involvements and recurrent flares after the induction of remission
In the comparison of serologically active clinically quiescent (SACQ) and Serologically quiescent clinically quiescent (SQCQ), there was no difference in the dose of antimalarials and whether to use immunosuppressants at the start of SACQ or SQCQ (Table 1)
Steiman AJ et al [23] investigated the levels of anti-dsDNA and antichromatin isotypes in SACQ patients, and the results showed that predicting clinical outcomes by serologic changes remains an elusive goal among SACQ patients
Summary
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem involvements and recurrent flares after the induction of remission. Anti-dsDNA antibodies have been recognized as a marker for disease activity, especially for renal injury [4,5,6,7]. These antibodies play a significant role in the exacerbation and flare of the disease [6, 8,9,10,11]. The Lupus Low Disease Activity State (LLDAS) was proposed in 2015 by the Asia-Pacific Lupus Collaboration as a consensus-based definition of minimally acceptable disease activity lupus patients, with the dosage of prednisone being no more than 7.5 mg/day [15]. It was reported that in Chinese patients, LLDAS is attainable as an early treatment target for SLE [16]
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