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Systemic Lupus ErythematosusTreat-to-Target

Lupus Remission and
Low Disease Activity State

Checks two treat-to-target definitions: DORIS 2021 remission and the lupus low disease activity state (LLDAS). Both are built from SLEDAI-2K items, a physician global assessment, and prednisone dose. Enter the values at the current visit.

Definitions
DORIS 2021 (van Vollenhoven et al.) and LLDAS (Franklyn et al.)
Lupus Sci Med 2021; Ann Rheum Dis 2016
1
SLEDAI-2K Items

Check each item present within the last 10 days. Items tagged Lab are laboratory-based. DORIS uses the clinical SLEDAI (all items except the Lab items). LLDAS uses the full SLEDAI-2K.

Neuropsychiatric and vascular
Renal (urinalysis)
Musculoskeletal and mucocutaneous
Serosal, hematologic, and serologic
Constitutional
2
Global Assessment and Treatment
Physician global assessment (SELENA-SLEDAI PGA, 0 to 3)
0 = no disease activity, 3 = maximal activity. Enter to one decimal place.
Current prednisone (or prednisolone) dose, mg per day
Enter the total daily dose at this visit. Enter 0 if not taking glucocorticoids.
Antimalarials, immunosuppressives, and biologics are at a stable, well-tolerated maintenance dose
Answer "No" if any of these were started, stopped, or escalated for lupus activity since the last visit.
New features of lupus activity compared with the previous assessment
Needed for LLDAS only. Answer "Yes" if any SLEDAI item is new or recurrent since the last visit.
LLDAS-only exclusions
LLDAS excludes hemolytic anemia and gastrointestinal lupus activity. Neither is a SLEDAI-2K item, so they are entered here.
📊 What Each Definition Requires
DefinitionRequirementsClinical Use
DORIS 2021Clinical SLEDAI = 0. PGA below 0.5. Prednisone 5 mg/day or less. Stable antimalarials, immunosuppressives, and biologics.Aspirational treatment target and research endpoint. Serologic activity is excluded from this definition.
LLDASSLEDAI-2K 4 or less, with no major organ activity and no hemolytic anemia or GI activity. No new features. PGA 1 or less. Prednisone 7.5 mg/day or less. Well-tolerated maintenance therapy.Low-activity target that allows some residual disease. Associated with reduced organ damage accrual in the validation cohort.

Neither definition replaces the physician's global judgment. Both were derived from research cohorts and are intended as treatment targets, not diagnostic criteria.

💡 Pearls and Pitfalls
✓
DORIS uses clinical SLEDAI, not full SLEDAI. Laboratory items (urinalysis, platelets, white count, complement, anti-dsDNA) are excluded from the DORIS calculation. Serologic activity alone does not break DORIS remission.
✓
LLDAS allows some residual activity. Arthritis, myositis, rash, alopecia, mucosal ulcers, low complement, anti-dsDNA, thrombocytopenia, and leukopenia can be present, as long as their combined SLEDAI points total 4 or less.
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Both definitions need the prednisone dose. A patient who is in remission on paper but still on 10 mg of prednisone does not meet DORIS. Record the dose at the same visit as the SLEDAI.
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Prednisone is a dose ceiling, not a target. These definitions check the dose at the visit. They do not measure how long a patient has been in the target state, and DORIS does not specify a duration.
🔬 Evidence

DORIS 2021 is the consensus definition of remission from an international task force of lupus specialists and patient representatives. It was built on clinical SLEDAI equal to zero, a physician global assessment below 0.5, prednisone 5 mg/day or less, and stable immunosuppressive, antimalarial, and biologic therapy.

LLDAS was defined by consensus using Delphi and nominal group methods. In a single-center cohort of 191 patients, attainment was associated with reduced organ damage accrual. The SLEDAI item list used here follows the SLEDAI-2K instrument, consistent with the SLEDAI-2K calculator on this site.

View References▾
1
Gladman DD, Ibanez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol. 2002;29(2):288-291.
2
van Vollenhoven RF, Bertsias G, Doria A, et al. 2021 DORIS definition of remission in SLE: final recommendations from an international task force. Lupus Sci Med. 2021;8:e000538. doi:10.1136/lupus-2021-000538
3
Franklyn K, Lau CS, Navarra SV, et al. Definition and initial validation of a Lupus Low Disease Activity State (LLDAS). Ann Rheum Dis. 2016;75(9):1615-1621.
For clinical decision support only. DORIS and LLDAS are treatment-target definitions. They do not replace assessment of disease activity and organ involvement by the treating physician. Applying them to a patient with recent or evolving organ involvement requires clinical judgment.
🔗 Related
🔬
SLEDAI-2K
Full disease activity score used by this checker
→ 🩺
Lupus Physician Global Assessment
The PGA input used in both definitions
→ 📋
SLE Classification Criteria
2019 EULAR/ACR
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SLEDAI-2K Score
0
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Clinical SLEDAI (DORIS): 0 · Lab items: 0
Inactive Disease
DORIS 2021 Remission
Enter the values to evaluate.
LLDAS
Enter the values to evaluate.
DORIS: cSLEDAI = 0 AND PGA < 0.5 AND prednisone <= 5 AND meds stable
LLDAS: SLEDAI-2K <= 4, no major organ items, PGA <= 1, no new features, prednisone <= 7.5, meds stable
Reviewed by Mahiar Rabie, MS, MD · AutoimmuneCalc