Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Towards Defining Clinical Remission in Juvenile Systemic Lupus Erythematosus (jSLE).

Mina5,  Rina, Schanberg6,  Laura E., Eberhard14,  B. Anne, Klein-Gitelman3,  Marisa S., Higgins12,  Gloria C., Onel17,  Karen, Singer11,  Nora G.

BC Childrens Hospital, Vancouver, BC, Canada
Medizinische Hochschule, Hannover, Germany
MetroHealth Medical Center, Cleveland, OH
Nationwide Childrens Hosp, Columbus, OH
OU Health Science Center, Oklahoma City, OK
Schneider Children's Hospital, New Hyde Park, NY
UNESP
Univ of Calif San Francisco, San Francisco, CA
Univ of Chicago, Chicago, IL
Childrens Hospital of NY, New York, NY
Childrens Mem Hosp/NW Univ, Chicago, IL
Cincinnati Children's Hospital, Cincinnati, OH
Cincinnati Children's Med Ctr, Cincinnati, OH
Duke Univ Medical Center, Durham, NC
Hospital General de Ninos Pedro de Elizalde, Buenos Aires, Argentina
IRCCS G Gaslini, Genova, Italy
IRCCS G Gaslini

Background:

There is no established definition for global clinical remission in jSLE.

Objectives:

To develop a definition of global clinical remission in jSLE and to identify candidate criteria for measuring jSLE clinical remission.

Methods:

Pediatric rheumatologists from all over the world (n=137) were surveyed about issues pertaining to defining and measuring clinical remission in jSLE. Consensus for the Delphi survey was set at 70%. Survey-responses were compared to prospective clinical data from a cohort of jSLE (n=33) considered to be in clinical remission by their treating physician.

Results:

Survey response rate was 65%. There was consensus that 'clinical remission' is different from 'minimal disease activity' in jSLE. There was consensus that a jSLE patient in clinical remission (a) may have some subjective symptoms (i.e. fatigue, joint pains, headaches) but should not have any objective physical signs of disease activity; (b) may have a persistently positive ANA but should not have abnormal ESR, C3 level, complete blood count and urine sediment; and thus (c) may have disease activity scores > 0. No consensus was reached as to whether remission constitutes a time point or a time period and whether medication use is important in its definition. Clinical data of jSLE patients considered to be in remission supported the survey responses (see Table).

Clinical Data from jSLE patients in Clinical Remission (n = 33)

Outcome measureMedian ± IQRRange
SLEDAI2 ± 30–6
ECLAM1 ± 00–3
SLAM2 ± 30–5
BILAG1 ± 20–10
Physician Global Assessment0 ± 00–1
Patient well being8 ± 16–9
Peds QoL90.22 ± 20.1156.52–100
Rheum QoL92.05 ± 10.2359.09–100
CHQ PhS42.76 ± 4.5235.43–48.89
CHQ PsS40.31 ± 5.4431.65–48.20
SLICC-ACR DI0 ± 00–3

Conclusions:

Consensus has been reached on preliminary variables useful to define and measure clinical remission in jSLE. Further studies are in progress.

To cite this abstract, please use the following information:
Mina, Rina, Schanberg, Laura E., Eberhard, B. Anne, Klein-Gitelman, Marisa S., Higgins, Gloria C., Onel, Karen, et al; Towards Defining Clinical Remission in Juvenile Systemic Lupus Erythematosus (jSLE). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1701
DOI: 10.1002/art.29466

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