“Treat-to-Target” in Systemic Lupus Erythematosus: Novel Definitions of Remission and Low Disease Activity

Abstract: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with alternating periods of activity and remission, where an accurate assessment of disease activity remains crucial for optimal treatment. For this purpose, various instruments and composite measures have been developed to enable objective evaluation and effective patient monitoring. In recent years, the SLE Disease Activity Score (SLE-DAS), validated in 2019, has emerged as a reliable and precise method. It combines 17 clinical and laboratory parameters, offering a more accurate assessment of disease activity. Furthermore, SLE-DAS defines clear criteria for remission and low disease activity, supporting the “treat-to-target” approach. Despite the significance of SLE-DAS, other scales such as the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and its modified versions, Systemic Lupus Activity Measure (SLAM), SLAQ (Systemic Lupus Activity Questionnaire), and the British Isles Lupus Assessment Group (BILAG) Index—continue to be used in clinical practice. Of these, SLEDAI-2K remains the most frequently employed tool in daily rheumatological practice. Despite the variety of tools available, SLE-DAS stands out for its precision, practicality, and wide applicability, both in routine clinical practice and clinical trials, emphasizing its broad utility in managing SLE.