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Objectives To assess the correlation between disease activity, organ damage and PROs.Methods An observational cross-sectional study including 339 consecutive SLE patients evaluated under a prospective T2T strategy at a single university hospital in Northern Spain. Disease activity was assessed using SLEDAI-2K and SLEDAS. Remission was defined by DORIS (clinical SLEDAI-2K=0, PGA less than 0.5, prednisone less than 5mg/day, and stable immunosuppressants). LLDAS was defined as SLEDAI-2K less than 4, no major organ activity, no new disease activity, PGA less than 1, and prednisone less than 7.5mg/day. Organ damage was measured with the SLICC/ACR Damage Index (SDI). Patient-reported outcomes (PROs) included HAQ and Lupus Impact Tracker (LIT). Associations between HAQ, SDI and remission status were analyzed.Results We studied 339 patients (89.1% female, mean age 53.2 ±14.6 years, median disease duration 127 months), 22.9% had lupus nephritis and 37.6% were receiving corticosteroids. Antimalarial use was common (80.6%). At evaluation, 57.9% fulfilled DORIS remission and 84.9% were in LLDAS. Nonetheless, 42.2% had SDI equal to 1 and 23.3% SDI equal to 2. Interestingly, 52.9% of patients not in remission or LLDAS had no damage (SDI=0). Among those in remission, 81% had HAQ scores between 0–1, compared to 60.7% of patients not achieving remission. Spearman’s correlation showed a significant association between HAQ and SDI (r=0.42; p<0.001). Correlations between remission status and HAQ (r=–0.31) and remission status and SDI (r=–0.28) were weaker but significant.Abstract PO:05:142 Table 1–2Conclusions A high proportion of patients achieved LLDAS (84.9%) and DORIS remission (57.9%). Still, 42.2% in remission had organ damage (SDI equal to 1), showing poor correlation between activity and damage. Thus, both indices should be assessed separately. HAQ correlated better with SDI, suggesting functional status reflects cumulative damage more reliably than activity alone.