Lupus Low Disease Activity State Associated With Reduced Damage, Lower Mortality in SLE

Systemic lupus erythematosus
Systemic lupus erythematosus
Researchers observed a reduction in mortality in patients with SLE who achieve a low disease activity state.

Study data published in Arthritis Care & Research support an association between achieving Lupus Low Disease Activity State (LLDAS-50) and a subsequent reduction in severe damage and mortality related to systemic lupus erythematosus (SLE).  

Investigators abstracted data from the Tromsø Lupus Cohort, a longitudinal population-based study of patients with SLE in Norway. The inception cohort comprised patients seen since 1990 who fulfilled at least 4 American College of Rheumatology criteria for SLE. Patients completed 2 or more annual visits at the local rheumatology center, during which details of the appointment were registered in the cohort database. Sociodemographic information and clinical data were recorded at each visit. Disease activity was quantified with the SLE Disease Activity Index (SLEDAI-2K) and damage was ascertained with the SLE Damage Index (SDI). LLDAS was described using the following 4 criteria: SLEDAI-2K ≤4, with no activity in major organ systems; no new features of lupus disease activity; current prednisolone (or equivalent) dose ≤7.5 mg/day; and well-tolerated standard maintenance doses of immunosuppressive drugs. LLDAS-50 described patients who spent at least 50% of their follow-up time in LLDAS.

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The Tromsø Lupus Cohort had a median follow-up time of 125 months, during which 3646 visits were made by 206 patients. At last follow-up, the majority (58%) of patients had a total SDI of ≥1, while 28% had a final SDI score of ≥3 and 22% had an increase in SDI score by ≥3 from baseline to last follow-up. LLDAS of any duration was achieved by 74% of the cohort and the median duration of LLDAS was 34 months.

A total of 69 patients (33.5%) spent less than half of the follow-up time in LLDAS, therefore achieving LLDAS-50. These patients had significantly better survival and lower risk of developing a severe level of SDI over time. After adjustments for age and sex, LLDAS-50 was associated with a significant reduction in risk for severe damage (hazard ratio [HR], 0.37; 95% CI, 0.19-0.73) and a reduction in mortality (HR, 0.31; 95% CI, 0.16-0.62; both P <.01). Similar protection against mortality was observed in patients who achieved LLDAS-30 (n=114) and LLDAS-70 (n=38), although achieving LLDAS-30 had no effect on severe damage.

These data validate prior findings that LLDAS-50 is associated with a reduction in severe damage. Additionally, both LLDAS-50 and LLDAS-70 appear to be associated with reductions in mortality. Further research is necessary to validate the latter finding and explore better therapeutic means to achieve LLDAS in patients with SLE.


Sharma C, Raymond W, Eilertsen G, Nossent J. Achieving Lupus Low Disease Activity State (LLDAS-50) is associated with both reduced damage accrual and mortality in patients with systemic lupus erythematosus [published online March 1, 2019]. Arthritis Care Res (Hoboken). doi:10.1002/acr.23867