| BackgroundSystemic lupus erythematosus(SLE)is an autoimmune mediated chronic autoimmune disease that can involve multiple systems such as skin and mucous membranes,skeletal muscles,blood,kidneys,and the nervous system.The pathogenesis of SLE is not yet fully understood.Most of the current pharmacological treatments for SLE are based on oral glucocorticoids(referred to as hormones),antimalarials,immunosuppressive drugs,etc.For patients with severe disease activity,large amounts of hormones are usually required to induce remission.However,while hormones are effective in treating SLE,they also bring various adverse effects.As the basic medication for SLE treatment,their cumulative dosage increases over time as the patient’s disease progresses,causing cumulative damage to the patient that should not be ignored.Several studies at home and abroad have demonstrated the feasibility of reducing or stopping hormone use in SLE patients,and recent guidelines on SLE treatment have also suggested that hormone use should be reduced or even stopped as much as possible when patients reach remission or low disease activity,in order to reduce the adverse effects caused by long-term hormone use and improve the prognosis of patients.Due to the significant heterogeneity of SLE disease and the different clinical manifestations and severity of the disease,there are no specific standards or protocols for how to effectively and safely reduce or discontinue hormones,and there are few studies in China that analyze the relapse of SLE patients after discontinuing hormones in remission.ObjectiveThrough the observation and analysis of SLE patients in remission with zero hormone maintenance therapy in our center,we investigated the risk factors associated with relapse in patients with zero hormone maintenance therapy and provided reference values for further optimization of SLE treatment strategies.MethodThis study included 75 patients with SLE in remission with glucocorticoids withdrawn maintenance therapy who were seen in the Department of Rheumatology and Immunology of the Hospital of Guangzhou Medical University from August 1,2020 to December 31,2022.All patients were in remission for at least three months prior to enrollment,had stopped taking hormones,and were treated only with hydroxychloroquine or immunosuppressants.According to the recurrence of SLE during the follow-up period,the patients were divided into the non-recurrence group and the recurrence group.The differences in clinical data between the two groups were analyzed and compared,so as to find the risk factors that might be related to recurrence.Results1.At the end of follow-up,the median duration of follow-up was 45(3,92)months,and 44 of the 75 patients included had no relapse and 31 patients had relapse,with a relapse rate of 41.3%(31/75).2.There were no significant differences in age at onset,age at drug withdrawal,course of disease at drug withdrawal,duration of remission of low-dose hormone(hormone ≤2.5mg/d),and course of disease at initial diagnosis between the two groups(P > 0.05),and there were statistically significant differences in scores of disease activity at initial diagnosis between the two groups(P=0.012).The disease activity score at first diagnosis was lower in the group without relapse than in the group with relapse.3.There was no statistical significance between the two groups in whether the two groups had positive anti-DS-DNA antibody and low complement C4 at the initial diagnosis or hormone withdrawal(P > 0.05).There was a statistical difference between the two groups in whether the two groups had high ESR at the initial onset(P=0.017).The proportion of patients in the relapse group with high ESR at the initial onset was higher than that in the non-relapse group.The proportion of patients with low complement C3 in the relapse group was higher than that in the non-relapse group,and the difference was statistically significant(P < 0.05).There was no significant difference in serological activity between the two groups(P > 0.05).4.Cox multivariate survival analysis found that the presence of low C3 was a risk factor for recurrence,and the dosage of hydroxychloroquine was a protective factor for recurrence.Patients who took hydroxychloroquine 400mg/d had a lower risk of recurrence than those who took hydroxychloroquine 200mg/d.ConclusionIn this study,patients with SLE who were on remission zero-hormone maintenance therapy in our center had mild or moderate activity at initial diagnosis,and this study found that patients with no relapse had lower activity scores than patients with relapse at initial diagnosis,and complement C3 lower than normal at initial diagnosis of SLE were risk factors for relapse.The dose of hydroxychloroquine is a protective factor affecting relapse in patients. |
