A monophasic disease course was observed among 7.5% of patients with systemic lupus erythematosus (SLE) in an inception cohort from the University of Toronto Lupus Clinic, Ontario, Canada, according to the results of a study published in The Journal of Rheumatology.

The researchers investigated inception patients who had been enrolled in the clinic within 18 months of their diagnosis. The objective of the study was to evaluate the prevalence and characteristics of a monophasic disease course in a defined inception SLE cohort over the course of 10 years of follow-up after achieving remission. A monophasic disease course was defined on the basis of the maintenance of complete clinical remission for the entire length of follow-up.

Among a total of 267 inception patients, 10.1% (n=27) attained prolonged clinical remission (≥10 years) and 7.5% sustained remission for the entire follow-up period (average, 18 years). Overall, 12 patients were receiving no maintenance therapy 10 years after achieving remission.


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Clinical manifestations at diagnosis in the 27 patients who achieved prolonged remission included mucocutaneous involvement (70.4%), arthritis (59.3%), cytopenias (55.6%), lupus nephritis (25.9%), central nervous system involvement (25.9%), serositis (18.5%), myositis (7.4%), and vasculitis (3.7%). Overall, about half of the patients were serologically active.

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Ten years after attaining remission, two-thirds of the inception patients had discontinued the use of glucocorticosteroids, and the remaining individuals received treatment with 5 mg/day, on average. After 10 years, 7 patients relapsed: 4 with arthritis, 2 with lupus nephritis, and 1 with catastrophic antiphospholipid syndrome.

The investigators concluded that further exploration of these inception patients who achieved long-term clinical remission might help  provide unique pathophysiologic insights into SLE and the accurate prognosis of the disease.

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Reference

Tselios K, Gladman DD, Touma Z, Su J, Anderson N, Urowitz MB. Monophasic disease course in systemic lupus erythematosus [published online June 1, 2018]. J Rheumatol. doi: 10.3899/jrheum.171319