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Objective To investigate the relationship between remission and health-related quality of life (HRQoL) in patients with SLE in a longitudinal observational cohort. Methods HRQoL was measured at cohort visits using the physical and mental component score (PCS and MCS, respectively) of the Short Form 36 questionnaire. Definitions of Remission in SLE remission categories (no remission/remission on therapy/remission off therapy) were applied. Determinants of PCS and MCS were identified with simple linear regression analyses. Association between remission and HRQoL was assessed using generalized estimating equation models. Results Data from 154 patients with 2 years of follow-up were analysed. At baseline 60/154 (39.0%) patients were in either form of remission. Patients in remission had higher Short Form 36 scores in all subdomains compared with patients not in remission. PCS was positively associated with remission and employment, and negatively associated with SLICC damage index, ESR, medication, patient global assessment and BMI. MCS was positively associated with Caucasian ethnicity and negatively associated with patient global assessment. In generalized estimating equation analysis, a gradual and significant increase of PCS was observed from patients not in remission (mean PCS 36.0) to remission on therapy (41.8) to remission off therapy (44.8). No significant difference in MCS was found between remission states. Conclusion we show a strong and persistent association between remission and PCS, but not MCS. These results support the relevance (construct validity) of the Definition of Remission in SLE remission definitions and the further development of a treat-to-target approach in SLE. [ABSTRACT FROM AUTHOR]

Objective: To determine whether intercurrent infections are a risk factor for subsequent disease flares in systemic lupus erythematosus (SLE)., Methods: Demographic and clinical characteristics of 203 patients with SLE participating in the Amsterdam SLE cohort were collected at baseline and during follow-up. Collection of data on infections and SLE flares was registry-based and infections and flares were categorised as minor or major, based on predefined criteria. Proportional hazard models with recurrent events and time-varying covariates were used to estimate the HR of SLE flares., Results: The incidence rates of major and minor infections were 5.3 per 100 patient years and 63.9 per 100 patient years, respectively. The incidence rates of flares were 3.6 and 15.1 per 100 patient years for major flares and minor flares, respectively.In the proportional hazard model, intercurrent infections (major and minor combined) were associated with the occurrence of SLE flares (major and minor combined; HR 1.9, 95% CI: 1.3 to 2.9). The hazard ratio for a major SLE flare following a major infection was 7.4 (95% CI: 2.2 to 24.6). Major infections were not associated with the occurrence of minor flares., Conclusions: The results of the present study show that intercurrent infections are associated with subsequent SLE flares, which supports the hypothesis that infections may trigger SLE flares., Competing Interests: Competing interests: IEMB reports personal fees from GSK, Eli Lilly, UCB, Roche, Sanofi Genzyme and AstraZeneca, outside the submitted work. FeH, MWPT-A-S, BIL-W and AEV have no conflicts of interest to declare., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Oncological survival and quality-of-life improved significantly after introduction of immune checkpoint inhibitors (ICIs). Immunotherapy, however, also decreases immunotolerance, potentially inducing autoimmune reactions. This can result in symptoms mimicking rheumatic diseases., Case Description: Patient A, 51-years-old, female, was treated with adjuvant nivolumab for metastatic melanoma. After 9 months, she developed arthritis. Prednisone 30 mg/ day and methotrexate significantly improved arthritis, followed by prednisone tapering. Patient B, 75-year-old, male with metastatic melanoma treated with Ipilimumab/Nivolumab developed malaise and reduced muscle strength shortly after treatment start. Patient was suspected of myositis/myocarditis, treated with methylprednisolone, which resulted in a rapid improvement., Conclusion: ICIs can cause rheumatic adverse events, resulting in decreased quality of life that may require immunesuppressive treatment. Disruption or cessation of ICIs may occur. These adverse events demand low-threshold rheumatological referral and collaboration between oncologist and rheumatologist. Further research must indicate the most effective immunosuppressive therapies with minimized negative oncological impact.

Background: Treat-to-target (T2T) is a therapeutic strategy currently being studied for its application in systemic lupus erythematosus (SLE). Patients and rheumatologists have little support in making the best treatment decision in the context of a T2T strategy, thus, the use of information technology for systematically processing data and supporting information and knowledge may improve routine decision-making practices, helping to deliver value-based care., Objective: To design and develop an online Clinical Decision Support Systems (CDSS) tool "SLE-T2T", and test its usability for the implementation of a T2T strategy in the management of patients with SLE., Methods: A prototype of a CDSS was conceived as a web-based application with the task of generating appropriate treatment advice based on entered patients' data. Once developed, a System Usability Score (SUS) questionnaire was implemented to test whether the eHealth tool was user-friendly, comprehensible, easy-to-deliver and workflow-oriented. Data from the participants' comments were synthesised, and the elements in need for improvement were identified., Results: The beta version web-based system was developed based on the interim usability and acceptance evaluation. 7 participants completed the SUS survey. The median SUS score of SLE-T2T was 79 (scale 0 to 100), categorising the application as 'good' and indicating the need for minor improvements to the design., Conclusions: SLE-T2T is the first eHealth tool to be designed for the management of SLE patients in a T2T context. The SUS score and unstructured feedback showed high acceptance of this digital instrument for its future use in a clinical trial., Competing Interests: Competing interests: RV declares that he has received research support (institutional grants) from BMS, GSK, Lilly and UCB and support for educational programs from Pfizer and Roche. RV declares that he has also received consulting fees from AbbVie, AstraZeneca, Biogen, Biotest, BMS, Galapagos, Gilead, Janssen, Pfizer, Sanofi, Servier, UCB and Vielabio and personal honoraria as a speaker from AbbVie, Galapagos, GSK, Janssen, Pfizer and UCB. AV declares that he has received research support (institutional grants) from GSK and UCB. AV declares that he has also received consulting fees from GSK, AstraZeneca, Roche and personal honoraria as a speaker from GSK., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Antimalarials (AMs) have been demonstrated to reduce disease activity and prevent damage accrual in SLE. Recent guidelines advise prescribing AMs in all patients with SLE. We present data from the Amsterdam Lupus Cohort on use, reasons for non-use, and dosage related intolerance of AMs, as well as disease related variables associated with non-use., Methods: AM use was assessed in all our SLE patients included in a longitudinal cohort study. Demographic and disease characteristics were compared between users and non-users of AMs. Daily dosages of hydroxychloroquine (HCQ) according to lean body weight were calculated., Results: Out of 190 SLE patients in the cohort, 139 (73.2%) were using AMs during their last visit, predominantly HCQ (136/139, 97.8%), while 92.1% (175/190) had ever used AMs. Daily dosage of HCQ was 400 mg in 115/136 (84.6%) patients. According to lean body weight, 119/136 (87.5%) had daily dosages of HCQ above the recommended 6.5 mg/kg. Patients did not use AMs (n=51) for the following reasons: intolerance (n=16), discontinued without a documented reason (n=11), never initiated (n=9), quiescent disease (n=7), contraindication (n=2), other (n=6). Only one patient discontinued HCQ due to AM-related retinopathy. Non-use of AMs was associated with a longer disease duration, higher damage accrual and a history of lupus nephritis., Conclusions: Despite increased awareness of the importance of AM treatment in SLE, there is still room for improvement, especially in patients with lupus nephritis and/or long-standing disease. Daily dosages of hydroxychloroquine often exceeded recommendations from guidelines, but are generally well-tolerated.