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Systemic lupus erythematosus in a multiethnic US cohort (LUMINA) XXVII: factors predictive of a decline to low levels of disease activity

Department of Medicine, Division of Clinical Immunology and Rheumatology

G S Alarcón

Department of Medicine, Division of Clinical Immunology and Rheumatology, graciela.alarcon{at}ccc.uab.edu

G McGwin

Department of Surgery, Section of Trauma, Burns, and Critical Care, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA

M Fernández

Department of Medicine, Division of Clinical Immunology and Rheumatology

H M Bastian

Department of Medicine, Division of Clinical Immunology and Rheumatology

B J Fessler

Department of Medicine, Division of Clinical Immunology and Rheumatology

L M Vilá

Department of Surgery, Section of Trauma, Burns, and Critical Care, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA

J D Reveille

Department of Medicine, Division of Rheumatology, The University of Texas Health Science Center at Houston, Houston, Texas, USA

LUMINA Study Group

The objective of this study was to examine factors predictive of a decline to low levels of disease activity in a cohort of systemic lupus erythematosus (SLE) patients. Patients with SLE of Hispanic (from Texas or Puerto Rico), African-American or Caucasian ethnicity from a multiethnic cohort were included. A decline to low levels of disease activity was defined as a score 5 as per the Systemic Lupus Activity Measure-Revised (SLAM-R) at any annual study visit if preceded by a SLAM-R 8. Using Generalized Estimating Equation (GEE), socioeconomic-demographic, behavioral, function, psychological, laboratory and clinical data [disease manifestations, number of ACR criteria accrued at diagnosis and damage accrual as per the Systemic Lupus International Collaborating Clinics (SLICC) Damage Index (SDI)] from the visit preceding that meeting the definition were examined as predictors of decline to low levels of disease activity. Two-hundred and eighty-seven patients (67 Hispanics from Texas, 32 Hispanics form Puerto Rico, 120 African-Americans and 68 Caucasians), accounting for 632 visits were analyzed. In the GEE multivariable analysis, higher degrees of social support (OR = 1.208, 95% CI 1.059-1.379; P = 0.005) were predictive of a decline to low levels of disease activity, while the number of ACR criteria accrued at diagnosis (OR = 0.765, 95% CI 0.631-0.927; P = 0.006) and damage (OR = 0.850, 95% CI 0.743-0.972, P = 0.018) were negatively associated. These data suggest that a decline to low levels of disease activity in lupus patients seems to be multifactorial; this study also underscores the importance of social support for lupus patients.

Key Words: systemic lupus erythematosus • disease activity • longitudinal cohort

Lupus, Vol. 15, No. 1, 13-18 (2006)
DOI: 10.1191/0961203306lu2256oa


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