Defining clinical remission and clinically inactive disease in juvenile systemic lupus erythematosus (jSLE)

Abstract

Background/Purpose: An initial Delphi survey delineated key commonalities for a standard definition of clinical remission and inactive disease in jSLE. However, additional clarifications were required. The aim of this project is to develop a definition of and criteria for clinical remission and inactive disease in jSLE. Methods: A second international Delphi survey was conducted among pediatric rheumatologists. Consensus was set at 75%. Data from a cohort of jSLE (n=36) patients considered to be in remission by their treating physician were compared to the results of the survey. Results: There were 311 respondents (response rate: 52%). Consensus was achieved regarding the key definitions under consideration (Table 1). Respondents agreed that with clinical remission: a) there could be at most one mild, non-limiting symptom (i.e. fatigue, joint pains, headaches or myalgia) but no objective physical signs of disease activity; b) the ANA could be persistently abnormal but not the complete blood count, urine sediment, and complement C3; and c) there could be regular use of several systemic medications (Table 1). Majority of the respondents stated that regular use of non-steroidal anti-inflammatory drugs and hydroxychloroquine with clinical remission were permissible. Data from jSLE patients supported the results of the survey. (Table Presented) Conclusion: Consensus has been reached on the definition of 'Clinical Remission' and 'Clinically Inactive Disease' in jSLE. The results of the Delphi process will be used to guide the data-driven development of provisional criteria of clinical remission and inactive disease in jSLE.