Phenotyping SLE based on disease course: remitting-relapsing, persistently active and monophasic

Dr. Murray Urowitz, University Health Network, Toronto, Ontario

Principal: Dr. Murray Urowitz

Team members: Dr. Dafna Gladman, Dr. Zahi Touma, Dr. Konstantinos Tselios, Dr. Jiandong Su

A major goal of clinical research in lupus is to improve disease management based on disease course. The significance and novelty of this research project lies in the opportunity to advance individualized care by precisely characterizing disease course. Patient identification and stratification early in the disease course will allow for targeted (or adjusted) therapies to prevent and/or reduce future lupus or drug-related complications.

The hypothesis of this research study was to test the clinical impression of the disease courses by modeling the course of the disease over time. Using our long term observational cohort we assessed the prevalence and characteristics of different patterns of disease course in the first 10 years after diagnosis of SLE.

Three patterns of disease course were found: Prolonged Remission (PR), Relapsing-Remitting (RR), Persistently Active (PA).

At 10 years, PA patients had more damage than the PR and RR patients. Black race and higher disease activity over the first 2 years were associated with a more severe disease course. RR and PA patients had an increased flare rate and accrued more osteoporosis, osteonecrosis and cardiovascular events.

In conclusion, the disease course pattern in SLE was primarily relapsing-remitting, while prolonged remission and persistently active disease were each observed in approximately 10% of the patients. Another 13% of the patients did not follow any of these “classic” patterns but achieved a solitary remission period of varying duration. The pattern of disease course and the time spent in remission were strongly related to damage accrual over 10 years as well as osteoporosis, osteonecrosis and atherosclerotic cardiovascular events over time.

This project was funded by a Lupus Canada Catalyst Grant and the Canadian Institutes of Health Research.