Validation of the revised definition of lupus low disease activity in patients with SLE

EULAR recently updated its recommendation for managing SLE by redefining the lupus low disease activity state (LLDAS) with a reduced allowable glucocorticoid dose of ≤5 mg. No studies have validated this revised definition. Thus, we aimed to evaluate its association with clinical outcomes, including organ damage, disease flares and quality of life.

A total of 299 SLE patients were enrolled and conducted annual follow-ups over 4 years. Disease flares were assessed based on changes from previous visits. Disease activity was measured using the SLE Disease Activity Index 2000 (SLEDAI-2K) and the Physician Global Assessment (PGA). Irreversible organ damage was evaluated using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Quality of life was assessed using the SF-36, with a focus on the Physical and Mental Component Summary (PCS and MCS) scores. Longitudinal analyses were performed using generalized estimating equations models to compare the revised and existing LLDAS definitions.

The revised LLDAS definition was significantly associated with reduced organ damage (SLICC/ACR SDI, β = -2.922; 95% CI: -3.294 to -2.550; P < 0.001), lower disease flare risk (odds ratio = 0.207; 95% CI: 0.083-0.515; P < 0.001) and improved mental health (SF-36 MCS, β = 1.219; 95% CI: 0.114-2.323; P = 0.031), showing comparable effectiveness to the existing definition.

The revised LLDAS definition demonstrated comparable clinical benefits, supporting its adoption in clinical practice for improved long-term SLE management.