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Inactive disease and remission in childhood‐onset systemic lupus erythematosus
Author(s) -
Mina Rina,
KleinGitelman Marisa S.,
Ravelli Angelo,
Beresford Michael W.,
Avcin Tadej,
Espada Graciela,
Eberhard B. Anne,
Schanberg Laura E.,
O'Neil Kathleen M.,
Silva Clovis A.,
Higgins Gloria C.,
Onel Karen,
Singer Nora G.,
von Scheven Emily,
Imundo Lisa F.,
Nelson Shannen,
Giannini Edward H.,
Brunner Hermine I.
Publication year - 2012
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.21612
Subject(s) - medicine , erythrocyte sedimentation rate , systemic lupus erythematosus , headaches , myalgia , anti nuclear antibody , disease , physical therapy , pediatrics , surgery , immunology , antibody , autoantibody
Objective 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). Methods 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). Results 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. Conclusion 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.