ArticleRMD open2026
Evaluating a guideline-aligned prednisone threshold within the Lupus Low Disease Activity State (LLDAS): associations with damage accrual.
Article in RMD open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo examine whether a modified Lupus Low Disease Activity State with a prednisone-equivalent threshold ≤5 mg/day (LLDAS-5) is more strongly associated with lower damage accrual than conventional LLDAS using a ≤7.5 mg/day threshold (LLDAS-7.5) in systemic lupus erythematosus (SLE).
methodsWe analysed 332 patients, including 105 incident cases. For each patient, yearly Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) worsening occasions and average proportion of follow-up spent in LLDAS-5 and LLDAS-7.5 were derived. Patient-level Poisson regression with follow-up years as the exposure and Huber's robust variance estimator estimated rate ratios (RRs). Parallel models were fitted for the two definitions. Full-cohort multivariable models adjusted for age, sex, ethnicity, SLE duration, baseline Systemic Lupus Erythematosus Disease Activity Index 2000 and baseline SDI.
resultsIn the full cohort, 142/332 patients experienced at least one SDI increase (190 occasions). Crude RRs were 0.61 (95% CI 0.37 to 1.00; p=0.052) for LLDAS-5 and 0.73 (95% CI 0.39 to 1.37; p=0.332) for LLDAS-7.5. Multivariable RRs were 0.56 (95% CI 0.37 to 0.86; p=0.007) and 0.47 (95% CI 0.27 to 0.85; p=0.012), respectively, with similar model fit. Among incident cases, 29/105 patients accrued damage (29 occasions); both LLDAS-5 (RR 0.31, 95% CI 0.11 to 0.89; p=0.029) and LLDAS-7.5 (RR 0.29, 95% CI 0.09 to 0.93; p=0.036) were associated with lower damage accrual.
conclusionLonger time in LLDAS-5 was robustly associated with less damage accrual. Crude full-cohort analyses suggested a numerically stronger inverse association and slightly better model fit for LLDAS-5, but this apparent advantage was not sustained after multivariable adjustment. These findings support LLDAS-5 as a clinically meaningful, guideline-aligned target, while its incremental prognostic value over conventional LLDAS-7.5 requires further study.
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