Achieving lupus low-disease activity and remission states under belimumab in refractory systemic lupus erythematosus: time and organ involvement matter

Objective: To determine whether migraine in systemic lupus erythematosus (SLE) is associated with accentuated brain injury and disease activity. Methods: Forty SLE patients (11 without headache, 11 with non-migraine headache, and 18 with migraine) underwent clinical evaluation, magnetic resonance imaging (MRI), and spectroscopy (MRS). Results: Recurrent headache occurred in 75% of SLE patients. MRI abnormalities and reduced N-acetylaspartate were common. However, migraine in SLE was not associated with increased disease activity or severity, neuropsychiatrie manifestations, or end-organ involvement compared to patients without migraine ( p>0.05). There were no differences in the prevalence or severity of MRI or MRS abnormalities between SLE patients with migraine, with non-migraine headache, or without headache ( p>0.05). Conclusions: Headache does not identify SLE patients at risk for brain injury, increased disease activity, or increased end-organ involvement. Aggressive immunosuppressive therapy for headache alone is not indicated in SLE.

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How can we define low disease activity in systemic lupus erythematosus?

Seminars in Arthritis and Rheumatism ◽

10.1016/j.semarthrit.2018.10.013 ◽

2019 ◽

Vol 48 (6) ◽

pp. 1035-1040 ◽

Cited By ~ 4

Author(s):

Konstantinos Tselios ◽

Dafna D Gladman ◽

Murray B Urowitz

Keyword(s):

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Low Disease Activity

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Increased CD4+CD25-Foxp3+ T cells in Chinese systemic lupus erythematosus: correlate with disease activity and organ involvement

Lupus ◽

10.1177/0961203318804881 ◽

2018 ◽

Vol 27 (13) ◽

pp. 2057-2068 ◽

Cited By ~ 5

Author(s):

Z-J Yin ◽

B-M Ju ◽

L Zhu ◽

N Hu ◽

J Luo ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

T Cells ◽

Disease Activity ◽

Lupus Erythematosus ◽

Cell Subset ◽

Treg Cells ◽

Organ Involvement ◽

Systemic Lupus ◽

Clinical Indicators ◽

Disease States

Objective The increment of CD4+CD25−Foxp3+T cells has been reported in systemic lupus erythematosus (SLE) patients. However, the exact identity of this T cell subset is still unclear. Thus, we analyzed CD4+CD25−Foxp3+T cells and Treg cells (CD4+CD25+Foxp3+ T cells) in a large sample of Chinese SLE patients in different disease states. Methods A total of 280 SLE patients and 38 healthy volunteers were enrolled, which included 21 patients with untreated new-onset lupus (UNOL), 13 patients with drug withdrawal more than 6 months and 246 patients with treatments. Phenotypic and functional analysis of peripheral blood CD4+CD25−Foxp3+ T cells and Treg cells were performed by flow cytometry. The correlation of CD4+CD25−Foxp3+T cells and Treg cells with disease activity, clinical indicators and organ involvement were analyzed. Results CD4+CD25−Foxp3+ T cells and Treg cells were significantly increased in SLE patients and showed significantly positive correlations with disease activity. CD4+CD25−Foxp3+ T cells were significantly increased in patients with skin and hematologic involvement as well as arthritis. Diverse changes between CD4+CD25−Foxp3+ T cells and Treg cells when faced with different medications, especially HCQ and MMF. CD4+CD25−Foxp3+ T cells expressed more IFN-γ and less CTLA-4 than CD4+CD25+Foxp3+ T cells, which were similar to CD4+CD25+Foxp3− T cells, and expressed similar IL-17, ICOS and Helios to CD4+CD25+Foxp3+ T cells. The synthesis capacity of IL-10 of CD4+CD25−Foxp3+ T cells and the expression of GITR on CD4+CD25−Foxp3+ T cells were between CD4+CD25+Foxp3+ and CD4+CD25+Foxp3− T cells. Conclusions Our results indicate that increased CD4+CD25−Foxp3+ T cells in lupus patients, which combined the features of suppression and pro-inflammatory, may serve as a biomarker for disease activity and organ involvement in SLE.

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Possibilities and prospects for glucocorticoid withdrawal in systemic lupus erythematosus

Modern Rheumatology Journal ◽

10.14412/1996-7012-2020-1-6-11 ◽

2020 ◽

Vol 14 (1) ◽

pp. 6-11

Author(s):

S. K. Solovyev ◽

E. A. Aseeva ◽

E. L. Nasonov ◽

A. M. Lila ◽

G. M. Koilubaeva

Keyword(s):

Quality Of Life ◽

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Lupus Erythematosus ◽

Social Adaptation ◽

The Other ◽

Systemic Lupus ◽

Low Disease Activity ◽

Pathogenetic Therapy

The efficiency of glucocorticoid (GC) therapy for systemic lupus erythematosus (SLE) is beyond question and is confirmed by the experience gained over many decades of their use. However, there are many problems with prolonged GC use, even in its low and medium doses. In particular, the development of GC-associated irreversible organ damages significantly worsens prognosis and causes a decrease in quality of life and social adaptation and a substantial increase in treatment costs. On the other hand, the current capabilities of early diagnosis, pathogenetic therapy, and monitoring in many patients with SLE allow for maintaining low disease activity and remission, the conditions in which the feasibility of further GC treatment can and should be decided. The paper gives the data available in the literature and the authors’ own studies on the possibility and prospects of GC withdrawal in SLE patients in a stage of low disease activity and remission.

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Low disease activity—irrespective of serologic status at baseline—associated with reduction of corticosteroid dose and number of flares in patients with systemic lupus erythematosus treated with belimumab: A real-life observational study

Seminars in Arthritis and Rheumatism ◽

10.1016/j.semarthrit.2018.02.014 ◽

2018 ◽

Vol 48 (3) ◽

pp. 467-474 ◽

Cited By ~ 26

Author(s):

Antonis Fanouriakis ◽

Christina Adamichou ◽

Sofia Koutsoviti ◽

Stylianos Panopoulos ◽

Chrysanthi Staveri ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Observational Study ◽

Disease Activity ◽

Lupus Erythematosus ◽

Real Life ◽

Systemic Lupus ◽

Low Disease Activity ◽

Corticosteroid Dose

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Time in remission and low disease activity state (LDAS) are associated with a better quality of life in patients with systemic lupus erythematosus: results from LUMINA (LXXIX), a multiethnic, multicentre US cohort

RMD Open ◽

10.1136/rmdopen-2019-000955 ◽

2019 ◽

Vol 5 (1) ◽

pp. e000955 ◽

Cited By ~ 4

Author(s):

Manuel Francisco Ugarte-Gil ◽

Guillermo J Pons-Estel ◽

Luis M Vila ◽

Gerald McGwin ◽

Graciela S Alarcón

Keyword(s):

Quality Of Life ◽

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Lupus Erythematosus ◽

Short Form ◽

Systemic Lupus ◽

Low Disease Activity ◽

Sf 36 ◽

Activity State

AimsTo determine whether the proportion of time systemic lupus erythematosus patients achieve remission/low disease activity state (LDAS) is associated with a better quality of life (QoL).Patients and methodsPatients from a well-established multiethnic, multicentre US cohort were included: remission: Systemic Lupus Activity Measure (SLAM) score=0, prednisone≤5 mg/day and no immunosuppressants); LDAS not in remission, SLAM score≤3, prednisone≤7.5 mg/day, no immunosuppressants; the combined proportion of time patients were in these states was the independent variable. The endpoints were the Physical and Mental Components Summary measures (PCS and MCS, respectively) and the individual subscales of the Short Form (SF)-36 at the last visit. Linear regression was used to estimate the association between the proportion of follow-up time in remission/LDAS and the SF-36 measures with and without adjustment for possible confounders.ResultsFour hundred and eighty-three patients were included. The per cent of time on remission/LDAS was associated with better QoL after adjusting for potential confounders; for the PCS the parameter estimate was 9.47 (p<0.0001), for the MCS 5.89 (p=0.0027), and for the subscales they ranged between 7.51 (p=0.0495) for mental health and 31.79 (p<0.0001) for role physical.ConclusionsThe per cent of time lupus patients stay on remission/LDAS is associated with a better QoL as measured by SF-36.

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Prolonged clinical remission and low disease activity statuses are associated with better quality of life in systemic lupus erythematosus

Lupus ◽

10.1177/0961203319862614 ◽

2019 ◽

Vol 28 (10) ◽

pp. 1189-1196 ◽

Cited By ~ 5

Author(s):

N Poomsalood ◽

P Narongroeknawin ◽

S Chaiamnuay ◽

P Asavatanabodee ◽

R Pakchotanon

Keyword(s):

Quality Of Life ◽

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Lupus Erythematosus ◽

Clinical Remission ◽

Life Questionnaire ◽

Systemic Lupus ◽

Low Disease Activity ◽

Significant Difference

Objective The objective of this study was to determine the association between disease activity status and health-related quality of life (HRQoL) in systemic lupus erythematosus (SLE) patients. Methods SLE patients in an out-patient clinic during the previous 12 months were included in the study. The Systemic Lupus Erythematosus-specific Quality-of-Life questionnaire (SLEQoL) was administered at the last visit. Disease activity status was determined retrospectively during the previous year. The categories of disease activity status were defined as: clinical remission (CR): clinical quiescent disease according to Systemic Lupus Erythematosus Disease Activity Index 2000, prednisolone ≤ 5 mg/day; low disease activity (LDA): SLEDAI-2K (without serological domain) ≤ 2, prednisolone ≤ 7.5 mg/day; and non-optimally controlled status: for those who were not in CR/LDA. Immunosuppressive drugs (maintenance dose) and antimalarials were allowed. Prolonged CR or LDA was defined as those with sustained CR or LDA for at least one year. The association between disease activity status and HRQoL was assessed by using regression analysis adjusting for other covariates. Results Of 237 SLE patients, 100 patients (42.2%) achieved prolonged CR, 46 patients (19.4%) achieved prolonged LDA and 91 patients (38.4%) were not in CR/LDA. Non-CR/LDA patients had significantly higher total SLEQoL score and in all domains compared to CR/LDA patients. 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 < 0.003). Moreover, non-CR/LDA was at a higher risk of impaired QoL (SLEQoL score > 80) compared with CR (hazard ratio 3.8; 95% CI 1.82–7.95; p < 0.001). However, there was no significant difference between CR and LDA in terms of SLEQoL score or impaired QoL. Other factors associated with higher SLEQoL score were damage index (β 9.51, 95% CI 3.52–15.49, p = 0.002) and anemia (β 24.99, 95% CI 5.71–44.27, p = 0.01). Conclusion 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 a treat to target approach in SLE.

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Predictors of Remission and Low Disease Activity State in Systemic Lupus Erythematosus: Data from a Multiethnic, Multinational Latin American Cohort

The Journal of Rheumatology ◽

10.3899/jrheum.180433 ◽

2019 ◽

Vol 46 (10) ◽

pp. 1299-1308 ◽

Cited By ~ 3

Author(s):

Manuel F. Ugarte-Gil ◽

Daniel Wojdyla ◽

Guillermo J. Pons-Estel ◽

Rosana Quintana ◽

José A. Gómez-Puerta ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Lupus Erythematosus ◽

Maintenance Dose ◽

Renal Involvement ◽

Immunosuppressive Drugs ◽

Older Age ◽

Systemic Lupus ◽

Low Disease Activity ◽

Activity State

Objective.To determine the predictors of remission and low disease activity state (LDAS) in patients with systemic lupus erythematosus (SLE).Methods.Three disease activity states were defined: Remission = SLE Disease Activity Index (SLEDAI) = 0 and prednisone ≤ 5 mg/day and/or immunosuppressants (maintenance dose); LDAS = SLEDAI ≤ 4, prednisone ≤ 7.5 mg/day and/or immunosuppressants (maintenance dose); and non-optimally controlled state = SLEDAI > 4 and/or prednisone > 7.5 mg/day and/or immunosuppressants (induction dose). Antimalarials were allowed in all groups. Patients with at least 2 SLEDAI reported and not optimally controlled at entry were included in these analyses. Outcomes were remission and LDAS. Multivariable Cox regression models (stepwise selection procedure) were performed for remission and for LDAS.Results.Of 1480 patients, 902 were non-optimally controlled at entry; among them, 196 patients achieved remission (21.7%) and 314 achieved LDAS (34.8%). Variables predictive of a higher probability of remission were the absence of mucocutaneous manifestations (HR 1.571, 95% CI 1.064–2.320), absence of renal involvement (HR 1.487, 95% CI 1.067–2.073), and absence of hematologic involvement (HR 1.354, 95% CI 1.005–1.825); the use of immunosuppressive drugs before the baseline visit (HR 1.468, 95% CI 1.025–2.105); and a lower SLEDAI score at entry (HR 1.028, 95% CI 1.006–1.051 per 1-unit decrease). These variables were predictive of LDAS: older age at entry, per 5-year increase (HR 1.050, 95% CI 1.004–1.098); absence of mucocutaneous manifestations (HR 1.401, 95% CI 1.016–1.930) and renal involvement (HR 1.344, 95% CI 1.049–1.721); and lower SLEDAI score at entry (HR 1.025, 95% CI 1.009–1.042).Conclusion.Absence of mucocutaneous, renal, and hematologic involvement, use of immunosuppressive drugs, and lower disease activity early in the course of the disease were predictive of remission in patients with SLE; older age was predictive of LDAS.

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