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Researchers from the Toronto Lupus Clinic have described an atypical “monophasic” course in a small number (7.5%) of systemic lupus erythematosus (SLE) patients who achieved and sustained clinical remission, with most off of all medications for an average of 18 years.
Their inception SLE cohort includes patients enrolled within 18 mos of diagnosis.
They defined a monophasic course as a SLEDAI 2000 = 0 (serology excluded) within 5 years since enrollment and maintained for ≥ 10 years of follow-up.
Among their 267 inception SLE patients, 27 (10.1%) achieved prolonged remission (≥ 10 yrs) and 20 (7.5%) sustained remission for the entire followup (average of 18 yrs).
Twelve patients were receiving no maintenance treatment 10 years after achieving remission. Half the patients were still serologically active. Ten years after achieving remission, two-thirds of the patients had discontinued glucocorticosteroids; the remaining were treated with 5 mg/day on average.
Relapse was seen in seven patients (after 10 years), with 4 developing arthritis, 2 lymphadenopathy and 1 with the catastrophic antiphospholipid syndrome.
Remission in lupus is rare but not unheard of. This single center, expert driven clinic finds a 10% or less chance of remission but that even in these patients relapse, years later, may still be seen; further suggesting the need for prolonged follow up care and guidance in patients with lupus.