Monday, 18 Mar 2019

You are here

Lower Mortality Results from Lower Activity in Lupus

Data from the longitudinal Tromsø Lupus Cohort study has shown that lupus patients who achieve a Lupus Low Disease Activity State (LLDAS‐50) were shown to have significantly less severe damage, and a reduction in mortality.

This was a population‐based study of SLE patients in the northern‐most counties of Norway.

They collected data on the LLDAS; defined as:

  1. SLEDAI‐2K ≤4, with no activity in major organ systems
  2. no new features of lupus disease activity
  3. current prednisolone (or equivalent) dose ≤7.5 mg daily, and,
  4. well tolerated standard maintenance doses of immunosuppressive drugs.

They followed a total of 206 SLE patients 84% female) with a median follow up of 125 months. Overall there were 46 (22%)  deaths.

Prednisolone (89%) and hydroxychloroquine (59%) were the most common drugs used and only 3.4% required cyclophosphamide or rituximab. A positive anti-nuclear antibody (ANA+) was evident in nearly all (96%).

LLDAS (any duration) was achieved by 74% of the cohort. The median time in LLDAS was 34 months and 69 patients (33.5%) spent at least half of their time in LLDAS. 

Lower mortality rates and a lower risk of severe damage was seen in the 69 patients (33.5%) who spent at least half of their follow up time in LLDAS.

The LLDAS‐50 was associated with a significantly lower in risk of having severe damage (HR 0.37; 95%CI 0.19 – 0.73, p < 0.01), and also a reduction in mortality (HR 0.31; 95%CI 0.16 – 0.62, p < 0.01).

Treat to target and measure of low activity can have a powerful effect on lupus outcomes. 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Brazilian Guidelines for Systemic Autoimmune Myopathies

The Myopathy Committee of the Brazilian Society of Rheumatology (BSR) has put forward recommendations for the management of patients with systemic autoimmune myopathies (SAM).

The challenge has been that there is a paucity of effective controlled clinical trials, and hence, glucocorticoids (GC) have played a first-line and prominent role in the treatment of SAM.

EULAR Consensus Guidelines for Juvenile Localized Scleroderma

A EULAR international committee of 15 experts in pediatric rheumatology have established consensus-based recommendations for the management of juvenile localised scleroderma (JLS).

JLS is an uncommon disorder that is commonly seen by pediatric and adult rheumatologists. Evidence-based guidelines are sparse and management is mostly based on physicians’ experience.

2018 Swedish Guidelines for Giant Cell Arteritis Treatment

The Swedish Society of Rheumatology has developed evidence-based guidelines for the management of giant cell arteritis (GCA) with a focus on the appropriate use of corticosteroids and tocilizumab. 

Congenital Heart Block: Dangers Ahead

Children of autoantibody-positive mothers who were born with congenital heart block were at high risk for developing later cardiovascular and autoimmune disorders, as were their siblings, Swedish researchers reported.

Lupus Microbiome May Drive Disease Activity

Silverman and colleagues have published their study of the fecal microbiome of systemic lupus erythematosus (SLE) patients and found roughly five times more gut bacteria known as Ruminococcus gnavus, and that these abnormalities in microbiota can correlate with measures of disease severity in SLE.