A new and unusual study describes a three- to 32-year follow-up analysis of systemic lupus erythematosus (SLE) patients to understand the number who achieve complete remission (three years) and subsequently remain in remission. The study, titled “Analysis of Complete Remission in Lupus Patients over a period of 32 years,” was published in the Arthritis Care & Research journal.
Systemic lupus erythematosus is a systemic autoimmune disease, manifested during a person’s adolescence or early 20s, that can affect various parts of the body, including the skin, joints, heart, lungs, blood, kidneys, and brain. In an autoimmune disease, the immune system cannot distinguish between foreign substances and its own cells and tissues, and generates “auto-antibodies” that cause inflammation, pain, and damage. SLE is characterized by high levels of auto-antibody production, activated T and B cells, several cytokine alterations, and clinical involvement in several organs. The standard SLE therapy has been the long-term use of immunosuppressive agents, with considerable side effects. Importantly, SLE is characterized by an irregular and fluctuating course, and because of this, there is no consensus as to the optimal criteria for SLE remission.
In this study, researchers wanted to identify lupus patients achieving complete disease remission as a single cohort of patients to be followed for up to 32 years, a significant period when compared to previous studies that limited outcome reporting to 5- and 10-year periods.
Enrolled patients (n=532) were followed in a University College Hospital Lupus, London, cohort for at least three years between 1978 and 2010. Complete remission was defined as a minimum three-year period of clinical inactivity (BILAG scores of C, D or E only) and laboratory remission (no antibodies to dsDNA and normal complement C3 levels), and no treatments with corticosteroids and immunosuppressive drugs. Antimalarials and non-steroidal anti-inflammatory drugs were allowed. In particular, the team wanted to determine the factors associated with complete remission.
The researchers identified patients in clinical but not in serological remission, with persistent serologic activity (increased anti-double-stranded DNA and/or decreased complement levels), with clinically quiescent disease (SACQ) defined as a ≥2-year persistent period without clinical activity. The analysis showed that of the 532 patients, 77 (14.5%) achieved complete remission for three years, but that 15 of the 67 patients remaining in this group (22.4%) went on to experience relapses after three years of remission. Relapses were even reported in three patients after 10 years of remission. As such, the researchers said, long-term follow-up of SLE is crucial.
This study had some limitations, including no evaluation of the cumulative dose and length of immunosuppressive therapy and total corticosteroid use during the follow-up period. Moreover, due to the small sample size, it was impossible to assess an association between the probability of remission types, and sex and ethnicity. Moreover, the complete array of factors or features that may influence remission and recurrence of patients were not identified.
Nonetheless, researchers believe these findings are important for a better understanding of the disease’s course and to guide rheumatologists with a patient’s disease management.