Is remission in systemic lupus erythematosus (SLE), a reality?

Abstract

To date, there are no universally accepted agreed-upon definitions of ‘remission’ in Systemic Lupus Erythematosus (SLE) because of the heterogeneity of the disease.^1,2 Most definitions regarding the concept of ‘remission’ in SLE are multiple. Over the past decades these concepts of remission have emerged as ‘nicknames’ where one would ideally like to achieve a ‘cure’. Cure in clinical terms is ‘the ultimate goal of medical intervention’, which in reality cannot realistically be hoped for’.³ The term remission was originally used in the practice of oncology to describe the total absence of any detectable tumour in patients. In the medical specialities treating autoimmune inflammatory diseases, the concept of remission has gained significant value when evaluating disease activity and in ‘treat-totarget’ therapies. Three distinct processes regarding the term remission have taken place:
- The idiom of remission was introduced into the language of speciality disciplines so that clinicians, researchers and patients would use this specific term to describe the state they wished to achieve.
- A preliminary definition of remission can specifically be defined for each disease, e.g. Rheumatoid Arthritis (RA). Remission in RA was defined by the American College of Rheumatology (ACR), in 1981.⁴ Subsequently, a definition of remission in RA was promulgated, based on the disease activity score or other disease activity indices. Finally, there is the joint ACR and European League Against Rheumatism (EULAR) definition of remission. ⁵
- Most notably in RA, remission was codified as the explicit target of therapeutic interventions. Remission has also been expressed in guidelines by the ACR⁶ and EULAR⁷ as well as the ‘treat-to-target’ work force group⁸ as the goal of therapy for ‘most’ patients.
These three developments cannot be understated as they strongly influence each other and have made the term remission a topic of discussion in a multitude of scientific publications and in patient-clinician encounters. In SLE, the concept of remission has also been debated extensively. In this brief review, previous and up-to-date developments regarding remission in SLE were accessed using MEDLINE/PUBMED searches of English language publications using Medical Subject Headings (MeSH). Terms and free text words for the following search keys: systemic lupus erythematosus (SLE), definitions of remission in SLE, quality of life and remission in SLE and patient outcomes and remission in SLE, were used. After reviewing all the articles the most relevant ones were then selected for this brief review.