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Objective: One objective in the treatment of systemic lupus erythematosus (SLE) disease activity is to reduce long‐term rates of organ damage. We undertook this study to analyze data from a large clinical SLE cohort to compare patients achieving different levels of disease activity with respect to rates of long‐term damage. Methods: We analyzed data from 1,356 SLE patients in the Hopkins Lupus Cohort, followed up quarterly, with 77,105 person‐months observed from 1987 to 2016. Three outcome measures were considered: clinical remission with no treatment, clinical remission on treatment, and lupus low disease activity state (LLDAS). Results: Patients achieved LLDAS in 50% of their follow‐up months. They achieved clinical remission with no treatment or clinical remission on treatment in only 13% and 27%, respectively, of their follow‐up visits. The rates of damage consistently declined with increased percentage of prior time in either LLDAS or clinical remission on treatment. Spending a short proportion of prior time (<25%) in clinical remission on treatment was associated with a relatively low rate of damage compared to never achieving that condition (1.01 events per 10 person‐years versus 1.82 events per 10 person‐years; rate ratio 0.54, P < 0.0001). Those patients who experienced LLDAS at least 50% of the time had relatively low rates of damage (rate ratio 0.39–0.47, P < 0.0001). Conclusion: LLDAS is an easier target to achieve than clinical remission on treatment and results in reduced risk of long‐term damage. However, even a small percentage of time in clinical remission on treatment was associated with reduced damage. [ABSTRACT FROM AUTHOR]

Objective: In 2016, the American Academy of Ophthalmology (AAO) changed the recommended daily dose of hydroxychloroquine (HCQ) from 6.5 mg/kg to <5 mg/kg. However, it is not clear that the lower prescribed dose of HCQ will have the same efficacy for systemic lupus erythematosus (SLE) activity or the same role in protecting against cardiovascular risk factors and thrombosis. This study was undertaken to address the frequency of HCQ retinopathy and the role of HCQ blood levels in identifying those individuals who are at a greater future risk of retinopathy. Methods: HCQ blood levels in 537 patients with SLE from a large clinical cohort were repeatedly measured, and patients were tested for HCQ retinopathy. We assessed the risk of retinopathy according to clinical characteristics and blood levels of HCQ. Results: The overall frequency of retinopathy was 4.3% (23 of 537 patients). There was a 1% risk of retinopathy in the first 5 years of HCQ treatment, 1.8% from 6 to 10 years, 3.3% from 11 to 15 years, 11.5% from 16 to 20 years, and 8.0% after 21 years of use. We found that older age (P < 0.0001), higher body mass index (P for trend = 0.0160), and longer duration of HCQ intake (P = 0.0024 and P for trend = 0.0006) were associated with a higher risk of HCQ toxicity. Higher blood levels of HCQ predicted later HCQ retinopathy (P = 0.0124 and P = 0.0340 for mean and maximum HCQ blood levels, respectively). Conclusion: Our data prove the utility of assessing blood levels of HCQ in the prediction of retinopathy. This would allow clinicians to either decrease the dose or increase monitoring in those patients with high HCQ blood levels. [ABSTRACT FROM AUTHOR]