To determine the difference in outcomes in patients who achieved or did not achieve the 2019 European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) criteria.
Patients from the LUpus in MInorities, NAture versus nurture (LUMINA) cohort were included. For these analyses, we compared those patients who achieved the 2019 EULAR/ACR criteria any time during follow-up to those who did not. The predefined outcomes were the last Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI) scores and survival. Univariable and multivariable negative binomial regression models were performed; adjustment models were based on a forward selection process.
In total, 98 of 640 patients never achieved the 2019 EULAR/ACR criteria. There was no difference in mean baseline SDI score among the patients who did not achieve the criteria compared to those who did. Conversely, the mean ± SD SDI score at last visit was lower for those who never achieved the criteria (1.2 ± 1.7 versus 2.0 ± 2.3, P = 0.0004). In the final adjusted model, the SDI score at last visit was 31% lower for those who never achieved the criteria (P = 0.0077). These patients were also more likely to survive, but this was not statistically significant.
In our cohort, patients who did not achieve the 2019 EULAR/ACR criteria accrued less damage, suggesting that these criteria could allow us to identify a subset of patients with more severe disease than allowed by previous criteria.