{
  "abstract": "Objectives To evaluate flares after sustained drug-free remission and their associated factors.Methods We studied SLE patients from a long-term longitudinal, multinational, multiethnic inception cohort; eligible patients were those who had >2 annual visits, who were not in remission at the baseline visit and who had achieved sustained drug-free remission during the follow-up. Sustained drug-free remission was defined as a SLEDAI-2K (excluding serology)=0, off prednisone and immunosuppressive drugs (IS) for two, three or five years; antimalarials were allowed. Flare, after achieving remission, was defined as any increase on the SLEDAI-2K (excluding serology) and/or the addition of prednisone and/or an IS during the follow-up. Potential predictors were sex, age at diagnosis, ethnicity, educational level, SLEDAI-2K domains and adjusted mean SLEDAI-2K from cohort entry to remission, baseline disease duration, time from baseline to remission, mean prednisone daily dose, IS and antimalarials from baseline to remission. Partially adjusted and multivariable Cox regression models were used, disease duration before remission was included in all models. Model 1 assessed sustained drug-free remission for at least two years, model 2 sustained drug-free remission for at least three years and model 3 for at least five years.Results 89 out of 183 (48.6%) patients who achieved remission for at least two years presented with a flare during follow-up; in patients with remission for at least three years flares were seen in 52 out of 123 (42.3%) and in those who achieved remission for at least five years in 25 out of 71 (35.2%). In the multivariable models, a shorter time to remission, the adjusted mean SLEDAI-2K and previous mucocutaneous involvement were associated with flares in those who achieved remission for at least two years, and previous renal involvement was associated with flares in those who achieved remission for at least three and five years ( tables 1 & 2).Abstract LBA:01:14 Table 1–2Conclusions Patients who achieve sustained drug-free remission remain at considerable risk for flares. Previous disease activity, renal and mucocutaneous involvement were associated with a higher probability of flare. The negative association between time to remission and risk of flare might reflect a need to improve the medication discontinuation strategies in SLE patients.",
  "authors": [
    {
      "affiliations": [
        "Universidad Cientifica del Sur, Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistemicas, Lima, Peru"
      ],
      "name": "Manuel Ugarte-Gil"
    },
    {
      "affiliations": [
        "University College London, Division of Medicine., London, United Kingdom"
      ],
      "name": "Anisur Rahman"
    },
    {
      "affiliations": [
        "Medical University of South Carolina, Charlestion, South Carolina, USA"
      ],
      "name": "Diane L Kamen"
    },
    {
      "affiliations": [
        "University of California at San Diego, School of Medicine, La Jolla, California, USA"
      ],
      "name": "Kenneth Kalunian"
    },
    {
      "affiliations": [
        "Karolinska Institutet/Karolinska University Hospital, Department of Medicine, Solna, Stockholm, Sweden"
      ],
      "name": "Elisabet Svenungsson"
    },
    {
      "affiliations": [
        "Dalhousie University, Department of Medicine, Halifax, Nova Scotia, Canada"
      ],
      "name": "Alexandra Legge"
    },
    {
      "affiliations": [
        "Queen Elizabeth II Science Centre & Dalhousie University, Department of Medicine and Department of Pathology, Halifax, Nova Scotia, Canada"
      ],
      "name": "John Hanly"
    },
    {
      "affiliations": [
        "Schroeder Arthritis Institute, Krembil Research Institute, Center for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada"
      ],
      "name": "Murray Urowitz"
    },
    {
      "affiliations": [
        "University of Birmingham, College of Medical and Dental Sciences, Institute of Inflammation and Ageing, Birmingham, United Kingdom"
      ],
      "name": "Caroline Gordon"
    },
    {
      "affiliations": [
        "Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea"
      ],
      "name": "Sang-Cheol Bae"
    },
    {
      "affiliations": [
        "Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Inmunología y Reumatología, Mexico City, Mexico"
      ],
      "name": "Juanita Romero-Diaz"
    },
    {
      "affiliations": [
        "Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Inmunología y Reumatología, Mexico City, Mexico",
        "University of Toronto, Division of Rheumatology, Toronto, Ontario, Canada"
      ],
      "name": "Jorge Sanchez-Guerrero"
    },
    {
      "affiliations": [
        "McGill University, Divisions of Rheumatology and Clinical Epidemiology, Montreal, Québec, Canada"
      ],
      "name": "Sasha Bernatsky"
    },
    {
      "affiliations": [
        "University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada"
      ],
      "name": "Ann Eliane Clarke"
    },
    {
      "affiliations": [
        "UCLA, Cedars Sinai/David Geffen School of Medicine, Los Angeles, California, USA"
      ],
      "name": "Daniel J Wallace"
    },
    {
      "affiliations": [
        "University College London, Division of Medicine., London, United Kingdom"
      ],
      "name": "David Alan Isenberg"
    },
    {
      "affiliations": [
        "Oklahoma Medical Research Foundation, Department of Clinical Pathology, Oklahoma City, Oklahoma, USA"
      ],
      "name": "Joan T Merrill"
    },
    {
      "affiliations": [
        "CHU de Québec - Université Laval, Centre ARThrite, Rheumatology, Quebec, Canada"
      ],
      "name": "Paul R Fortin"
    },
    {
      "affiliations": [
        "Schroeder Arthritis Institute, Krembil Research Institute, Center for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada"
      ],
      "name": "Dafna Gladman"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester Academic Health Sciences Center, Manchester, United Kingdom"
      ],
      "name": "Ian N Bruce"
    },
    {
      "affiliations": [
        "Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA"
      ],
      "name": "Michelle Petri"
    },
    {
      "affiliations": [
        "SUNY Downstate Medical Center, Department of Medicine, Brooklyn, New York, USA"
      ],
      "name": "Ellen M Ginzler"
    },
    {
      "affiliations": [
        "University of North Carolina, Thurston Arthritis Research Center. Chapel Hill, North Carolina. USA"
      ],
      "name": "Mary Anne Dooley"
    },
    {
      "affiliations": [
        "Northwestern University and Feinberg School of Medicine, Department of Medicine. Chicago, Illinois. USA"
      ],
      "name": "Rosalind Ramsey-Goldman"
    },
    {
      "affiliations": [
        "Allegheny Health Network, Lupus Center of Excellence. Pittsburgh, Pennsylvania. USA"
      ],
      "name": "Susan Manzi"
    },
    {
      "affiliations": [
        "Lund University, Department of Clinical Sciences Lund, Rheumatology. Lund. Sweden"
      ],
      "name": "Andreas Jönsen"
    },
    {
      "affiliations": [
        "The Feinstein Institute for Medical Research, Northwell Health Manhasset. Manhasset, New York. USA"
      ],
      "name": "Cynthia Aranow"
    },
    {
      "affiliations": [
        "The Feinstein Institute for Medical Research, Northwell Health Manhasset. Manhasset, New York. USA"
      ],
      "name": "Meggan Mackay"
    },
    {
      "affiliations": [
        "Universityof the Basque Country, BioCruces Bizkaia Health Research Institute. Balakaldo. Spain"
      ],
      "name": "Guillermo Ruiz-Irastorza"
    },
    {
      "affiliations": [
        "Emory University, School of Medicine, Division of Rheumatology. Atlanta, Georgia. USA"
      ],
      "name": "Sam Lim"
    },
    {
      "affiliations": [
        "Istanbul University, Istanbul Medical Faculty. Capa, Istanbul. Turkey"
      ],
      "name": "Murat Inanc"
    },
    {
      "affiliations": [
        "Copenhagen University, Copenhagen Research Center for Autoimmune Connective Tissue Diseases, Rigshospitalet. Copenhagen. Denmark"
      ],
      "name": "Soren Jacobsen"
    },
    {
      "affiliations": [
        "University of Manitoba, Departments of Medicine and Community Health Sciences. Winnipeg, Manitoba. Canada"
      ],
      "name": "Christine Peschken"
    },
    {
      "affiliations": [
        "Columbia University Irving Medical Center. New York, New York. USA"
      ],
      "name": "Anca Askanase"
    },
    {
      "affiliations": [
        "Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR). Rosario. Argentina"
      ],
      "name": "Bernardo A Pons-Estel"
    },
    {
      "affiliations": [
        "The University of Alabama at Birmingham, Marnix E. Heersink School of Medicine. Birmingham, Alabama. USA",
        "Universidad Peruana Cayetano Heredia, Facultad de Medicina. Lima. Perú"
      ],
      "name": "Graciela S Alarcón"
    },
    {
      "affiliations": [
        "Amsterdam University Medical Centers, Department of Rheumatology. Amsterdam. The Netherlands"
      ],
      "name": "Ronald F van Vollenhoven"
    }
  ],
  "title": "LBA:01:14 Flare after achieving sustained drug-free remission in SLE: higher risk in patients with high prior disease activity, and in those with renal and mucocutaneous involvement. Data from the SLICC (system",
  "uid": "a15af72e-9cfc-524d-912f-2c11d0fc36cf"
}