Inactive disease and remission in childhood-onset systemic lupus erythematosus
Article first published online: 23 APR 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis Care & Research
Volume 64, Issue 5, pages 683–693, May 2012
How to Cite
Mina, R., Klein-Gitelman, M. S., Ravelli, A., Beresford, M. W., Avcin, T., Espada, G., Eberhard, B. A., Schanberg, L. E., O'Neil, K. M., Silva, C. A., Higgins, G. C., Onel, K., Singer, N. G., von Scheven, E., Imundo, L. F., Nelson, S., Giannini, E. H. and Brunner, H. I. (2012), Inactive disease and remission in childhood-onset systemic lupus erythematosus. Arthritis Care Res, 64: 683–693. doi: 10.1002/acr.21612
- Issue published online: 2 APR 2012
- Article first published online: 23 APR 2012
- Accepted manuscript online: 11 JAN 2012 02:13PM EST
- Manuscript Accepted: 7 JAN 2012
- Manuscript Received: 26 AUG 2011
- NIH. Grant Numbers: U01-AR51868, U01-AR055054, P30-AR AR47363, P60-AR047884, UL1RR026314
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Grant Number: Training grant T32100291
To define inactive disease (ID) and clinical remission (CR) and to delineate variables that can be used to measure ID/CR in childhood-onset systemic lupus erythematosus (cSLE).
Delphi questionnaires were sent to an international group of pediatric rheumatologists. Respondents provided information about variables to be used in future algorithms to measure ID/CR. The usefulness of these variables was assessed in 35 children with ID and 31 children with minimally active lupus (MAL).
While ID reflects cSLE status at a specific point in time, CR requires the presence of ID for >6 months and considers treatment. There was consensus that patients in ID/CR can have <2 mild nonlimiting symptoms (i.e., fatigue, arthralgia, headaches, or myalgia) but not Raynaud's phenomenon, chest pain, or objective physical signs of cSLE; antinuclear antibody positivity and erythrocyte sedimentation rate elevation can be present. Complete blood count, renal function testing, and complement C3 all must be within the normal range. Based on consensus, only damage-related laboratory or clinical findings of cSLE are permissible with ID. The above parameters were suitable to differentiate children with ID/CR from those with MAL (area under the receiver operating characteristic curve >0.85). Disease activity scores with or without the physician global assessment of disease activity and patient symptoms were well suited to differentiate children with ID from those with MAL.
Consensus has been reached on common definitions of ID/CR with cSLE and relevant patient characteristics with ID/CR. Further studies must assess the usefulness of the data-driven candidate criteria for ID in cSLE.