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We are grateful to Daniel Villalba and Leonardo Grasso for assistance with the ARTHROS software. The GLADEL group acknowledges PANLAR (Pan American League of Associations for Rheumatology) for its support of the SLE study group.

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Gomez-Puerta, Jose AAuthor

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Predictors of Remission and Low Disease Activity State in Systemic Lupus Erythematosus: Data from a Multiethnic, Multinational Latin American Cohort

Publicated to:Journal Of Rheumatology. 46 (10): 1299-1308 - 2019-10-01 46(10), DOI: 10.3899/jrheum.180433

Authors: Ugarte-Gil, Manuel F.; Wojdyla, Daniel; Pons-Estel, Guillermo J.; Quintana, Rosana; Gomez-Puerta, Jose A.; Catoggio, Luis J.; Alvarellos, Alejandro; Saurit, Veronica; Borba, Eduardo; Sato, Emilia; Costallat, Lilian; Da Silva, Nilzio A.; Iglesias-Gamarra, Antonio; Neira, Oscar; Reyes-Llerena, Gil; Cardiel, Mario H.; Amigo, Mary Carmen; Acevedo-Vasquez, Eduardo; Esteva-Spinetti, Maria H.; Alarcon, Graciela S.; Pons-Estel, Bernardo A.;

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Abstract

Objective. To determine the predictors of remission and low disease activity state (LDAS) in patients with systemic lupus erythematosus (SLE). Methods. Three disease activity states were defined: Remission = SLE Disease Activity Index (SLEDAI) = 0 and prednisone <= 5 mg/day and/or immunosuppressants (maintenance dose); LDAS = SLEDAI <= 4, prednisone <= 7.5 mg/day and/or immunosuppressants (maintenance dose); and non-optimally controlled state = SLEDAI > 4 and/or prednisone > 7.5 mg/day and/or immunosuppressants (induction dose). Antimalarials were allowed in all groups. Patients with at least 2 SLEDAI reported and not optimally controlled at entry were included in these analyses. Outcomes were remission and LDAS. Multivariable Cox regression models (stepwise selection procedure) were performed for remission and for LDAS. Results. Of 1480 patients, 902 were non-optimally controlled at entry; among them, 196 patients achieved remission (21.7%) and 314 achieved LDAS (34.8%). Variables predictive of a higher probability of remission were the absence of mucocutaneous manifestations (HR 1.571, 95% CI 1.064-2.320), absence of renal involvement (HR 1.487, 95% CI 1.067-2.073), and absence of hematologic involvement (HR 1.354, 95% CI 1.005-1.825); the use of immunosuppressive drugs before the baseline visit (HR 1.468, 95% CI 1.025-2.105); and a lower SLEDAI score at entry (HR 1.028, 95% CI 1.006-1.051 per 1-unit decrease). These variables were predictive of LDAS: older age at entry, per 5-year increase (HR 1.050, 95% CI 1.004-1.098); absence of mucocutaneous manifestations (HR 1.401, 95% CI 1.016-1.930) and renal involvement (HR 1.344, 95% CI 1.049-1.721); and lower SLEDAI score at entry (HR 1.025, 95% CI 1.009-1.042). Conclusion. Absence of mucocutaneous, renal, and hematologic involvement, use of immunosuppressive drugs, and lower disease activity early in the course of the disease were predictive of remission in patients with SLE; older age was predictive of LDAS.

Keywords

Caucasian patientsDamage indexInitial validationLow disease activity statePrevalenceProlonged remissionRemissionRisk factorsSleSystemic lupus erythematosusTargetTreat

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Journal Of Rheumatology due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2019, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Rheumatology.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 1.03. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Field Citation Ratio (FCR) from Dimensions: 7.53 (source consulted: Dimensions Jun 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-06-09, the following number of citations:

  • WoS: 23
  • Scopus: 26
  • Europe PMC: 10
  • OpenCitations: 23

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-06-09:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 46.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 46 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 20.9.
  • The number of mentions on the social network X (formerly Twitter): 22 (Altmetric).

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Argentina; Brazil; Chile; Colombia; Cuba; Mexico; Peru; United States of America; Venezuela.