Disease course following High Disease Activity Status revealed patterns in SLE
Abstract Background We sought to examine the disease course of High Disease Activity Status (HDAS) patients and their different disease patterns in a real-world longitudinal cohort. Disease resolution till Lupus Low Disease Activity State (LLDAS) has been a general treatment goal, but there is limit...
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doaj-9134a5ab46454648aa100f80e88dd02b2021-07-18T11:05:35ZengBMCArthritis Research & Therapy1478-63622021-07-012311910.1186/s13075-021-02572-1Disease course following High Disease Activity Status revealed patterns in SLEAlberta Hoi0Rachel Koelmeyer1Julie Bonin2Ying Sun3Amy Kao4Oliver Gunther5Hieu T. Nim6Eric Morand7Centre for Inflammatory Diseases, School of Clinical Sciences, Monash UniversityCentre for Inflammatory Diseases, School of Clinical Sciences, Monash UniversityCentre for Inflammatory Diseases, School of Clinical Sciences, Monash UniversityMerck Healthcare KGaAEMD Serono, EMD Serono Research & Development Institute, Inc, a business of Merck KGaAMerck Healthcare KGaAFaculty of Information Technology, Monash UniversityCentre for Inflammatory Diseases, School of Clinical Sciences, Monash UniversityAbstract Background We sought to examine the disease course of High Disease Activity Status (HDAS) patients and their different disease patterns in a real-world longitudinal cohort. Disease resolution till Lupus Low Disease Activity State (LLDAS) has been a general treatment goal, but there is limited information on this subset of patients who achieve this. Methods All consenting patients of the Monash Lupus Cohort who had at least 12 months of observation were included. HDAS was defined as SLEDAI-2K ≥ 10 ever, and HDAS episode as the period from the first HDAS clinic visit until attainment of LLDAS. We examined the associations of different HDAS patterns with the likelihood of damage accrual. Results Of 342 SLE patients, 151 experienced HDAS at least once, accounting for 298 HDAS episodes. The majority of HDAS patients (76.2%) experienced Recurrent HDAS (> 1 HDAS visit), and a smaller subset (47.7%) had Persistent HDAS (consecutive HDAS visits for longer than 2 months). Recurrent or Persistent HDAS patients were younger at diagnosis and more likely to experience renal or serositis manifestations; persistent HDAS patients were also more likely to experience neurological manifestations. Baseline SLEDAI greater than 10 was associated with longer HDAS episodes. Recurrent and Persistent HDAS were both associated with an increased likelihood of damage accrual. The total duration of HDAS episode greater than 2 years and experiencing multiple HDAS episodes (≥4) was also associated with an increased likelihood of damage accrual (OR 1.80, 95% CI 1.08–2.97, p = 0.02, and OR 3.31, 95% CI 1.66–13.26, p = 0.01, respectively). Conclusion HDAS episodes have a highly variable course. Recurrent and Persistent HDAS, and longer duration of HDAS episodes, increased the risk of damage accrual. In addition to a major signifier of severity in SLE, its resolution to LLDAS can determine the subsequent outcome in SLE patients.https://doi.org/10.1186/s13075-021-02572-1 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Alberta Hoi Rachel Koelmeyer Julie Bonin Ying Sun Amy Kao Oliver Gunther Hieu T. Nim Eric Morand |
spellingShingle |
Alberta Hoi Rachel Koelmeyer Julie Bonin Ying Sun Amy Kao Oliver Gunther Hieu T. Nim Eric Morand Disease course following High Disease Activity Status revealed patterns in SLE Arthritis Research & Therapy |
author_facet |
Alberta Hoi Rachel Koelmeyer Julie Bonin Ying Sun Amy Kao Oliver Gunther Hieu T. Nim Eric Morand |
author_sort |
Alberta Hoi |
title |
Disease course following High Disease Activity Status revealed patterns in SLE |
title_short |
Disease course following High Disease Activity Status revealed patterns in SLE |
title_full |
Disease course following High Disease Activity Status revealed patterns in SLE |
title_fullStr |
Disease course following High Disease Activity Status revealed patterns in SLE |
title_full_unstemmed |
Disease course following High Disease Activity Status revealed patterns in SLE |
title_sort |
disease course following high disease activity status revealed patterns in sle |
publisher |
BMC |
series |
Arthritis Research & Therapy |
issn |
1478-6362 |
publishDate |
2021-07-01 |
description |
Abstract Background We sought to examine the disease course of High Disease Activity Status (HDAS) patients and their different disease patterns in a real-world longitudinal cohort. Disease resolution till Lupus Low Disease Activity State (LLDAS) has been a general treatment goal, but there is limited information on this subset of patients who achieve this. Methods All consenting patients of the Monash Lupus Cohort who had at least 12 months of observation were included. HDAS was defined as SLEDAI-2K ≥ 10 ever, and HDAS episode as the period from the first HDAS clinic visit until attainment of LLDAS. We examined the associations of different HDAS patterns with the likelihood of damage accrual. Results Of 342 SLE patients, 151 experienced HDAS at least once, accounting for 298 HDAS episodes. The majority of HDAS patients (76.2%) experienced Recurrent HDAS (> 1 HDAS visit), and a smaller subset (47.7%) had Persistent HDAS (consecutive HDAS visits for longer than 2 months). Recurrent or Persistent HDAS patients were younger at diagnosis and more likely to experience renal or serositis manifestations; persistent HDAS patients were also more likely to experience neurological manifestations. Baseline SLEDAI greater than 10 was associated with longer HDAS episodes. Recurrent and Persistent HDAS were both associated with an increased likelihood of damage accrual. The total duration of HDAS episode greater than 2 years and experiencing multiple HDAS episodes (≥4) was also associated with an increased likelihood of damage accrual (OR 1.80, 95% CI 1.08–2.97, p = 0.02, and OR 3.31, 95% CI 1.66–13.26, p = 0.01, respectively). Conclusion HDAS episodes have a highly variable course. Recurrent and Persistent HDAS, and longer duration of HDAS episodes, increased the risk of damage accrual. In addition to a major signifier of severity in SLE, its resolution to LLDAS can determine the subsequent outcome in SLE patients. |
url |
https://doi.org/10.1186/s13075-021-02572-1 |
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