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Systemic Lupus Erythematosus: HELP
Articles by Sasha R. Bernatsky
Based on 87 articles published since 2009
(Why 87 articles?)
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Between 2009 and 2019, S. Bernatsky wrote the following 87 articles about Lupus Erythematosus, Systemic.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Review Managing cancer risk in patients with systemic lupus erythematous. 2018

Ladouceur, Alexandra / Bernatsky, Sasha / Ramsey-Goldman, Rosalind / Clarke, Ann E. ·a Medical Resident. Division of Internal medicine , University of Montreal , Montreal , Canada. · b Division of Rheumatology , McGill University Health Center, McGill University , Montreal , Canada. · c Division of Rheumatology , Feinberg School of Medicine, Northwestern University , Chicago , IL , USA. · d Division of Rheumatology , Cumming School of Medicine, University of Calgary , Calgary , AB , Canada. ·Expert Rev Clin Immunol · Pubmed #30183456.

ABSTRACT: INTRODUCTION: Numerous studies have clearly demonstrated that there is an altered cancer risk profile in patients with systemic lupus erythematous (SLE) versus the general population. This includes a higher risk of certain cancers (e.g. hematologic, lung) and a decreased risk of others (e.g. breast cancer). Several determinants could be behind this altered risk; these include immunosuppressant drugs, viral exposures, genetic factors, and other variables. Area covered: We review what is known regarding specific risk profiles and risk factors for some key cancers in SLE, including hematologic malignancies and lung cancers. In light of this, we examine current guidelines and practices regarding cancer screening, and propose ways that patients and physicians might help manage cancer risk in SLE. Expert commentary: Despite significant progress over the past decade, not many risk factors have been precisely identified. A better understanding of the elements that drive malignancy risk in systemic autoimmune rheumatic diseases may permit the further development of guidelines (regarding. cancer screening) for SLE patients. ABBREVIATIONS: AbTG: Anti-thyroglobulin antibodies; AbTPO: Anti-peroxydase antibodies; AML: Acute myeloid leukemia; APRIL: A proliferating-inducing ligand; BAFF: B-cell activating factor; CAPA: Canadian Arthritis Patient Alliance; CI: Confidence interval; CIN: Cervical intraepithelial neoplasia; CT: Computed tomography; DLBCL: Diffuse large B cell lymphoma; dsDNA: Double-stranded DNA; EBV: Epstein-Barr virus; EULAR European League Against Rheumatism; IBD: Inflammatory bowel disease; HBV: Hepatitis B virus; HCV: Hepatitis C virus; HIV: Human immunodeficiency virus; HR: Hazard ratio; HSIL: High-grade cervical squamous intraepithelial lesions; HSV: Herpes simplex virus; HL: Hodgkin lymphoma; HPV: Human papillomavirus; MALT: Mucosa-associated lymphoid tissue; MDS: Myelodysplastic syndrome; MESNA: 2-mercaptoethane sodium sulfonate; NHL: Non-Hodgkin lymphoma; OR: Odds ratio; Pap: Papanicolaou; RA: Rheumatoid arthritis; SLE: Systemic Lupus erythematous; SLICC: Systemic International Collaborating Clinics; SNPs: Single-nucleotide polymorphisms; SOGC: Society of Obstetricians and Gynaecologists of Canada.

2 Review A review on SLE and malignancy. 2017

Choi, May Y / Flood, Kelsey / Bernatsky, Sasha / Ramsey-Goldman, Rosalind / Clarke, Ann E. ·Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, T2N 4N1, Alberta, Canada. Electronic address: may.choi@ucalgary.ca. · Northwestern University and Feinberg School of Medicine, 420 E Superior St, Chicago, 60611, Illinois, USA. Electronic address: kelsey.flood@northwestern.edu. · Divisions of Rheumatology, McGill University Health Centre, McGill University, A6-1650 Cedar Avenue A6.163, Montreal, H3G 1A4, Quebec, Canada. Electronic address: sasha.bernatsky@mcgill.ca. · Division of Rheumatology, Northwestern University and Feinberg School of Medicine, 633 N. St. Clair, 18th Floor, Chicago, 60611, Illinois, USA. Electronic address: rgramsey@northwestern.edu. · Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, T2N 4N1, Alberta, Canada. Electronic address: aeclarke@ucalgary.ca. ·Best Pract Res Clin Rheumatol · Pubmed #29224679.

ABSTRACT: Systemic lupus erythematosus (SLE) is a chronic, systemic autoimmune disease characterized by autoantibody production, complement activation, and immune complex deposition. It predominantly affects young and middle-aged women. While improvements in the diagnosis and treatment of SLE have altered prognosis, morbidity and mortality rates remain higher than the general population. In addition to renal injury, cardiovascular disease, and infection, malignancy is known to be a significant cause of death in this population. There is increasing evidence to suggest that patients with SLE have a slightly higher overall risk of malignancy. The risk of malignancy in SLE is of considerable interest because the immune and genetic pathways underlying the pathogenesis of SLE and the immunosuppressant drugs (ISDs) used in its management may mediate this altered risk. Our current understanding of these and other risk factors and the implications for treating SLE and screening for malignancy is still evolving. This review summarizes the association between SLE and malignancy. The first section discusses the risk of overall and site-specific malignancies in both adult- and pediatric-onset SLE. Next, we evaluate the risk factors and possible mechanisms underlying the link between malignancy and SLE, including the use of ISDs, presence of certain SLE-related autoantibodies, chronic immune dysregulation, environmental factors, and shared genetic susceptibility. Finally, we review guidelines regarding cancer screening and vaccination for human papilloma virus.

3 Review Outcomes in Children Born to Women with Rheumatic Diseases. 2017

Vinet, Évelyne / Bernatsky, Sasha. ·Division of Clinical Epidemiology, McGill University Health Centre, Pine Avenue, Montreal, Québec H3A 1A1, Canada; Division of Rheumatology, McGill University Health Centre, Cedar Avenue, Montreal, Québec H3G 1A4, Canada. ·Rheum Dis Clin North Am · Pubmed #28390568.

ABSTRACT: Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are the most prevalent autoimmune rheumatic diseases, predominantly occurring in women during childbearing years. Research has focused on assessing the risk of immediate complications during SLE and RA pregnancies, with studies documenting a higher risk of adverse obstetric outcomes, such as preterm births and infants small for gestational age. Until recently, little was known regarding the long-term health of children born to affected women. We present a review of the current evidence regarding the risk of adverse health outcomes in SLE and RA offspring, and potential mechanisms involved in their pathogenesis.

4 Review DNA-damaging autoantibodies and cancer: the lupus butterfly theory. 2016

Noble, Philip W / Bernatsky, Sasha / Clarke, Ann E / Isenberg, David A / Ramsey-Goldman, Rosalind / Hansen, James E. ·Department of Therapeutic Radiology, Yale School of Medicine, 15 York Street, New Haven, Connecticut 06520, USA. · Department of Medicine, Divisions of Rheumatology and Clinical Epidemiology, McGill University, 687 Avenue des Pins Quest, Montreal, Quebec H3A 1A1, Canada. · Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada. · Centre for Rheumatology, Department of Medicine, Rayne Building, 5 University Street, University College London, London WC1E 6JF, UK. · Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, 240 East Huron Street, Chicago, Illinois 60611, USA. · Yale Cancer Center, Yale School of Medicine, 15 York Street, New Haven, Connecticut 06520, USA. ·Nat Rev Rheumatol · Pubmed #27009542.

ABSTRACT: Autoantibodies reactive against host DNA are detectable in the circulation of most people with systemic lupus erythematosus (SLE). The long-held view that antibodies cannot penetrate live cells has been disproved. A subset of lupus autoantibodies penetrate cells, translocate to nuclei, and inhibit DNA repair or directly damages DNA. The result of these effects depends on the microenvironment and genetic traits of the cell. Some DNA-damaging antibodies alone have little impact on normal cells, but in the presence of other conditions, such as pre-existing DNA-repair defects, can become highly toxic. These findings raise new questions about autoimmunity and DNA damage, and reveal opportunities for new targeted therapies against malignancies particularly vulnerable to DNA damage. In this Perspectives article, we review the known associations between SLE, DNA damage and cancer, and propose a theory for the effects of DNA-damaging autoantibodies on SLE pathophysiology and cancer risk.

5 Review Malignancies in systemic lupus erythematosus: a 2015 update. 2015

Goobie, Gillian C / Bernatsky, Sasha / Ramsey-Goldman, Rosalind / Clarke, Ann E. ·aDepartment of Medicine, Cumming School of Medicine, Health Sciences Centre, Foothills Campus, University of Calgary, Calgary, Alberta bDepartment of Medicine and of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada cDivision of Rheumatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA dDivision of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. ·Curr Opin Rheumatol · Pubmed #26125105.

ABSTRACT: PURPOSE OF REVIEW: Patients with systemic lupus erythematosus (SLE) have altered incidences of certain malignancies as compared with the general population. This review summarizes the recent literature on risk of malignancy in SLE and proposed mechanisms for these altered susceptibilities. RECENT FINDINGS: Recent studies have confirmed previous data showing an increased risk of non-Hodgkin's lymphoma, lung, liver, vulvar/vaginal, and thyroid malignancies, whereas demonstrating a decreased risk of breast and prostate cancer. Lymphomagenesis in SLE has been linked to increased activity of multiple inflammatory cytokines as well as possible viral diseases. The decreased rates of hormone-sensitive cancers, such as breast and prostate, are speculated to be related to the presence of lupus autoantibodies and downregulation of certain proteins in SLE. This knowledge has been utilized to investigate new therapeutic modalities for these malignancies. SUMMARY: Recent data confirm previously reported altered malignancy rates in SLE. Most striking in recent years are publications further elucidating mechanisms underlying cancer development in SLE, and subsequent investigations of potential therapeutics modulating these pathways.

6 Review What investigations are needed to optimally monitor for malignancies in SLE? 2015

Tessier-Cloutier, B / Clarke, A E / Pineau, C A / Keeling, S / Bissonauth, A / Ramsey-Goldman, R / Lee, J / Bernatsky, S. ·McGill University Health Centre, Division of Clinical Epidemiology, Montreal, Canada. · University of Calgary, Division of Rheumatology, Calgary, Canada. · Montreal General Hospital, Division of Rheumatology, Montreal, Canada. · University of Alberta, Division of Rheumatology, Edmonton, Canada. · Northwestern University Feinberg School of Medicine, Chicago, IL, USA. · McGill University Health Centre, Division of Clinical Epidemiology, Montreal, Canada sasha.bernatsky@mcgill.ca. ·Lupus · Pubmed #25742688.

ABSTRACT: OBJECTIVE: The overall cancer incidence risk in systemic lupus erythematosus (SLE) is approximately 15%-20% more than in the general population. Nevertheless, to date, the optimal malignancy screening measures in SLE remain undefined. Our objective is to determine what investigations are needed to optimally monitor for malignancies in SLE in order to inform upcoming Canadian Rheumatology Association recommendations. METHODS: We conducted a systematic search looking at three scientific sources, Embase, Medline and Cochrane, in an attempt to identify cancer screening recommendations for patients with SLE. We used a filter for observational studies and included articles published in 2000 and onward. RESULTS: The initial search strategy led to 986 records. After removal of duplicates and articles unrelated to SLE, we were left with 497 titles. From those, 79 research articles on cancer incidence in SLE were isolated and reviewed. Of the 79 original research papers, 25 offered screening recommendations, 14 suggested additional cancer screening whereas 11 studies simply promoted adherence to general population screening measures. The suggestions for more rigorous screening included recommending human papilloma virus testing in addition to routine cervical screening, and/or that cervical screening should be performed annually and/or suggested urine cancer screening in SLE patients with a history of cyclophosphamide exposure. CONCLUSIONS: We found no original research studies directly comparing cancer screening strategies in SLE. Generally, authors recommend adherence to general population screening measures, particularly cervical screening. This, possibly with adding targeted screening in special cases (e.g. annual urine cytology in patients with prior cyclophosphamide exposure, and considering existing lung cancer screening guidelines for past heavy smokers), may be a reasonable approach for cancer screening in SLE.

7 Review Systemic lupus erythematosus and malignancies: a review article. 2014

Tessier-Cloutier, Basile / Clarke, Ann E / Ramsey-Goldman, Rosalind / Gordon, Caroline / Hansen, James E / Bernatsky, Sasha. ·Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue, V Building, Montreal, Quebec H3A 1A1, Canada. · Division of Rheumatology, University of Calgary, 3330 Hospital Drive Northwest, Calgary, Alberta T2N 4N1, Canada. · Division of Rheumatology, Northwestern University Feinberg School of Medicine, McGaw Pavilion, 240 East Huron Street, Suite M-300, Chicago, IL 60611, USA. · Division of Rheumatology, College of Medical and Dental Sciences, University of Birmingham, Edgbaston B15 2TT, UK. · Department of Therapeutic Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA. · Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue, V Building, Montreal, Quebec H3A 1A1, Canada. Electronic address: sasha.bernatsky@mcgill.ca. ·Rheum Dis Clin North Am · Pubmed #25034158.

ABSTRACT: The systemic lupus erythematosus (SLE) population has a unique cancer risk profile. This article presents the most recent data on risk of cancer in lupus and discusses possible contributing factors. The risk of lymphoma is particularly increased in SLE and may be mediated by immunosuppressive medication. Lung cancer risk is also increased in SLE. There is a high rate of cervical dysplasia in women with SLE. A similar pathophysiology could be responsible for the trend seen in vulvovaginal and hepatic carcinomas. There is a decreased risk in SLE for some hormone-sensitive cancers, but the cause of this remains unclear.

8 Review Neurodevelopmental disorders in children born to mothers with systemic lupus erythematosus. 2014

Vinet, É / Pineau, C A / Clarke, A E / Fombonne, É / Platt, R W / Bernatsky, S. ·Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Canada Division of Rheumatology, McGill University Health Centre, Montreal, Canada evelyne.vinet@mail.mcgill.ca. · Division of Rheumatology, McGill University Health Centre, Montreal, Canada. · Division of Rheumatology, University of Calgary, Calgary, Canada. · Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, USA. · Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada. · Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Canada Division of Rheumatology, McGill University Health Centre, Montreal, Canada. ·Lupus · Pubmed #24969080.

ABSTRACT: Children born to women with systemic lupus erythematosus seem to have a potentially increased risk of neurodevelopmental disorders compared to children born to healthy women. Recent experimental data suggest in utero exposure to maternal antibodies and cytokines as important risk factors for neurodevelopmental disorders. Interestingly, women with systemic lupus erythematosus display high levels of autoantibodies and cytokines, which have been shown, in animal models, to alter fetal brain development and induce behavioral anomalies in offspring. Furthermore, subjects with systemic lupus erythematosus and neurodevelopmental disorders share a common genetic predisposition, which could impair the fetal immune response to in utero immunologic insults. Moreover, systemic lupus erythematosus pregnancies are at increased risk of adverse obstetrical outcomes and medication exposures, which have been implicated as potential risk factors for neurodevelopmental disorders. In this article, we review the current state of knowledge on neurodevelopmental disorders and their potential determinants in systemic lupus erythematosus offspring.

9 Review Systemic lupus and malignancies. 2012

Bernatsky, Sasha / Kale, Mruganka / Ramsey-Goldman, Rosalind / Gordon, Caroline / Clarke, Ann E. ·Division of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada. sasha.bernatsky@mail.mcgill.ca ·Curr Opin Rheumatol · Pubmed #22227880.

ABSTRACT: PURPOSE OF REVIEW: Individuals with systemic lupus erythematosus (SLE) have an increased susceptibility to certain types of cancer. Given concerns focused on this issue, we present a review of this important topic. RECENT FINDINGS: In non-Hodgkin lymphoma (NHL), a several-fold increased risk is seen in SLE versus the general population. It has long been suspected that immunosuppressive drugs play a role in this risk, but there may be other important driving factors as well. Lupus disease activity may itself heighten the risk of lymphoma in diseases like SLE. Lung cancer risk also is increased in SLE; smoking appears to drive this risk. Additionally, cervical dysplasia risk is increased in SLE, particularly with immunosuppressive drug exposure. An altered clearance of cancer-related viral agents in SLE (due to the disease and/or immunosuppression) may contribute to this risk and may also drive the risk for other cancers (such as vulvovaginal and hepatic carcinomas) in SLE. On the positive side, one new and significant finding is that SLE patients seem to have a decreased risk of certain nonhematologic cancers (breast, ovarian, endometrial, and prostate). SUMMARY: Though much has been learnt so far regarding the risk in SLE, much yet remains unknown.

10 Review Prostate cancer in systemic lupus erythematosus. 2011

Bernatsky, S / Ramsey-Goldman, R / Gordon, C / Clarke, A E. ·McGill University Health Centre, Montreal, QC, Canada. sasha.bernatsky@mail.mcgill.ca ·Int J Cancer · Pubmed #21448902.

ABSTRACT: Our research objective was to estimate prostate cancer risk in systemic lupus erythematosus (SLE), relative to the age-matched general population. A progressive literature review was performed to identify SLE cohort studies with cancer registry linkage for cancer ascertainment. Data were pooled from four studies of large SLE cohorts who met these criteria. The total number of prostate cancers observed was derived by pooling the incident cases across all studies. The total expected number of prostate, derived from applying appropriate general population cancer incidence data to the observed number of patient-years of follow-up for each study, was similarly determined. The parameter of interest was the standardized incidence ratio (SIR), the ratio of observed to expected malignancies. The four studies together provided a pool of 6,068 male SLE patients observed for a total of 38,186 patient-years (mean 6.3 years). Within these subjects, 80 prostate cancers were observed. In each contributing study, the number of cancers expected far exceeded that observed. The pooled SIR estimate for prostate cancer risk in males with SLE, compared to the general population, was 0.72 (95% CI 0.57, 0.89). These data suggest a decreased risk of prostate cancer in SLE; more definite conclusions require additional data. As alterations in androgen pathways can potentially alter prostate risk, a lower risk of prostate cancer in SLE could possibly be due to low hypoadrenergic states which some believe may occur in men with SLE; underlying genetic factors could also be at play. Further study of these issues in large cohorts is needed.

11 Review Lupus and cancer. 2009

Gayed, M / Bernatsky, S / Ramsey-Goldman, R / Clarke, Ae / Gordon, C. ·Rheumatology Research Group, School of Immunity and Infection, University of Birmingham, Edgbaston, Birmingham, UK. ·Lupus · Pubmed #19395448.

ABSTRACT: Individuals with systemic lupus erythematosus (SLE) have an increased susceptibility to certain types of cancer. Of particular concern are haematologic malignancies, specifically non-Hodgkin lymphoma, where a three- to four-fold increased risk is seen in SLE, compared with the general population. There is some evidence that immunosuppressive exposures play a role, although there appear to be other factors driving the risk. Lupus disease activity, with resultant dysregulated lymphocyte proliferation, may itself be a mediator of the association between SLE and lymphoma. Aside from haematologic malignancy risk, lung cancer also is increased in SLE compared with the general population, and smoking likely drives this risk in large part. Last but not least, cervical dysplasia is a concern in women with SLE, particularly with exposure to immunosuppressants; routine screening for this complication should not be neglected.

12 Article Brief Report: Risk of Childhood Rheumatic and Nonrheumatic Autoimmune Diseases in Children Born to Women With Systemic Lupus Erythematosus. 2018

Couture, Julie / Bernatsky, Sasha / Scott, Susan / Pineau, Christian A / Vinet, Evelyne. ·CHU Sainte-Justine, Montreal, Quebec, Canada. · McGill University Health Centre, Montreal, Quebec, Canada. ·Arthritis Rheumatol · Pubmed #29790298.

ABSTRACT: OBJECTIVE: Several autoimmune diseases have familial aggregation and, possibly, common genetic predispositions. In a large population-based study, we evaluated whether children born to mothers with systemic lupus erythematosus (SLE) have an increased risk of rheumatic and nonrheumatic autoimmune diseases versus children born to mothers without SLE. METHODS: Using the Offspring of SLE Mothers Registry, we identified children born live to SLE mothers and their matched controls, and ascertained autoimmune diseases based on ≥1 hospitalization or ≥2 physician visits with a relevant diagnostic code. We adjusted for maternal age, education, race/ethnicity, obstetric complications, calendar birth year, and sex of child. RESULTS: A total of 509 women with SLE had 719 children, while 5,824 matched controls had 8,493 children. The mean ± SD follow-up period was 9.1 ± 5.8 years. Children born to mothers with SLE had a similar frequency of rheumatic autoimmune diagnoses (0.14%; 95% confidence interval [95% CI] 0.01-0.90) versus controls (0.19% [95% CI 0.11-0.32]). There was a trend toward more nonrheumatic autoimmune diseases in SLE offspring (1.11% [95% CI 0.52-2.27]) versus controls (0.48% [95% CI 0.35-0.66]). In multivariate analyses, we did not see a clear increase in rheumatic autoimmune disease (odds ratio [OR] 0.71 [95% CI 0.11-4.82]), but children born to mothers with SLE had a substantially increased risk of nonrheumatic autoimmune disease versus controls (OR 2.30 [95% CI 1.06-5.03]). CONCLUSION: Although the vast majority of offspring have no autoimmune disease, children born to women with SLE may have an increased risk of nonrheumatic autoimmune diseases versus controls. Additional studies assessing offspring through to adulthood would be additionally enlightening.

13 Article Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort. 2018

Little, Jayne / Parker, Ben / Lunt, Mark / Hanly, John G / Urowitz, Murray B / Clarke, Ann E / Romero-Diaz, Juanita / Gordon, Caroline / Bae, Sang-Cheol / Bernatsky, Sasha / Wallace, Daniel J / Merrill, Joan T / Buyon, Jill / Isenberg, David A / Rahman, Anisur / Ginzler, Ellen M / Petri, Michelle / Dooley, Mary Anne / Fortin, Paul / Gladman, Dafna D / Steinsson, Kristjan / Ramsey-Goldman, Rosalind / Khamashta, Munther A / Aranow, Cynthia / Mackay, Meggan / Alarcón, Graciela S / Manzi, Susan / Nived, Ola / Jönsen, Andreas / Zoma, Asad A / van Vollenhoven, Ronald F / Ramos-Casals, Manuel / Ruiz-Irastorza, Guillermo / Sam Lim, Sung / Kalunian, Kenneth C / Inanc, Murat / Kamen, Diane L / Peschken, Christine A / Jacobsen, Soren / Askanase, Anca / Sanchez-Guerrero, Jorge / Bruce, Ian N. ·Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK. · NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. · Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. · Lupus Program, Centre for Prognosis Studies in The Rheumatic Disease and Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. · Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. · Instituto Nacional de Ciencias Médicas y Nutrición, Immunology and Rheumatology, Mexico City, Mexico. · Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK. · Rheumatology department, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK. · Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea. · Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada. · Cedars-Sinai Medical Centre, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. · Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA. · Division of Rheumatology, Department of Medicine, New York School of Medicine, NY, USA. · Centre for Rheumatology, Department of Medicine, University College London, London, UK. · Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA. · Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA. · Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Québec City, Canada. · Center for Rheumatology Research, Landspitali University hospital, Reykjavik, Iceland. · Division of Rheumatology, Feinberg School of Medicine, Northwestern University Chicago, IL, USA. · Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK. · Feinstein Institute for Medical Research, Manhasset, NY, USA. · Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. · Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, PA, USA. · Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden. · Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK. · Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm, Sweden. · Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain. · Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain. · Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, USA. · University of California San Diego School of Medicine, La Jolla, CA, USA. · Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey, USA. · Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. · Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. · Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. · Hospital for Joint Diseases, New York University, Seligman Centre for Advanced Therapeutics, New York, NY, USA. · Department of Rheumatology, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada. ·Rheumatology (Oxford) · Pubmed #29361147.

ABSTRACT: Objectives: To describe glucocorticoid (GC) use in the SLICC inception cohort and to explore factors associated with GC use. In particular we aimed to assess temporal trends in GC use and to what extent physician-related factors may influence use. Methods: Patients were recruited within 15 months of diagnosis of SLE from 33 centres between 1999 and 2011 and continue to be reviewed annually. Descriptive statistics were used to detail oral and parenteral GC use. Cross sectional and longitudinal analyses were performed to explore factors associated with GC use at enrolment and over time. Results: We studied 1700 patients with a mean (s.d.) follow-up duration of 7.26 (3.82) years. Over the entire study period, 1365 (81.3%) patients received oral GCs and 447 (26.3%) received parenteral GCs at some point. GC use was strongly associated with treatment centre, age, race/ethnicity, sex, disease duration and disease activity. There was no change in the proportion of patients on GCs or the average doses of GC used over time according to year of diagnosis. Conclusion: GCs remain a cornerstone in SLE management and there have been no significant changes in their use over the past 10-15 years. While patient and disease factors contribute to the variation in GC use, between-centre differences suggest that physician-related factors also contribute. Evidence-based treatment algorithms are needed to inform a more standardized approach to GC use in SLE.

14 Article Cerebrovascular Events in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. 2018

Hanly, John G / Li, Qiuju / Su, Li / Urowitz, Murray B / Gordon, Caroline / Bae, Sang-Cheol / Romero-Diaz, Juanita / Sanchez-Guerrero, Jorge / Bernatsky, Sasha / Clarke, Ann E / Wallace, Daniel J / Isenberg, David A / Rahman, Anisur / Merrill, Joan T / Fortin, Paul / Gladman, Dafna D / Bruce, Ian N / Petri, Michelle / Ginzler, Ellen M / Dooley, M A / Steinsson, Kristjan / Ramsey-Goldman, Rosalind / Zoma, Asad A / Manzi, Susan / Nived, Ola / Jonsen, Andreas / Khamashta, Munther A / Alarcón, Graciela S / Chatham, Winn / van Vollenhoven, Ronald F / Aranow, Cynthia / Mackay, Meggan / Ruiz-Irastorza, Guillermo / Ramos-Casals, Manuel / Lim, S Sam / Inanc, Murat / Kalunian, Kenneth C / Jacobsen, Soren / Peschken, Christine A / Kamen, Diane L / Askanase, Anca / Theriault, Chris / Farewell, Vernon. ·Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. · MRC Biostatistics Unit, Institute of Public Health, University of Cambridge, Cambridge, UK. · Toronto Western Hospital and University of Toronto, Ontario, Canada. · University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK. · Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea. · Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico. · McGill University, Montreal, Quebec, Canada. · University of Calgary, Alberta, Canada. · Cedars-Sinai Medical Center and University of California at Los Angeles, David Geffen School of Medicine, Los Angeles. · University College London, London, UK. · Oklahoma Medical Research Foundation, Oklahoma City. · Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Canada. · Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK, and Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK. · Johns Hopkins University School of Medicine, Baltimore, Maryland. · State University of New York Downstate Medical Center, Brooklyn. · University of North Carolina, Chapel Hill. · Landspitali University Hospital, Reykjavik, Iceland. · Northwestern University and Feinberg School of Medicine, Chicago, Illinois. · Lanarkshire Centre for Rheumatology and Hairmyres Hospital, East Kilbride, Scotland UK. · Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania. · Lund University, Lund, Sweden. · Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London, UK. · University of Alabama at Birmingham, Birmingham. · Karolinska Institute, Stockholm, Sweden. · Feinstein Institute for Medical Research, Manhasset, New York. · Hospital Universitario Cruces and University of the Basque Country, Barakaldo, Spain. · Institut d'Investigacions Biomèdiques August Pi I Sunyer, IDIBAPS, Hospital Clínic, Barcelona, Spain. · Emory University, Atlanta, Georgia. · Istanbul University, Istanbul, Turkey. · University of California at San Diego, La Jolla. · Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. · University of Manitoba, Winnipeg, Manitoba, Canada. · Medical University of South Carolina, Charleston. · New York University, New York, New York. ·Arthritis Care Res (Hoboken) · Pubmed #29316357.

ABSTRACT: OBJECTIVE: To determine the frequency, characteristics, and outcomes of cerebrovascular events (CerVEs), as well as clinical and autoantibody associations in a multiethnic/racial inception cohort of patients with systemic lupus erythematosus (SLE). METHODS: A total of 1,826 patients were assessed annually for 19 neuropsychiatric (NP) events, including 5 types of CerVEs: 1) stroke, 2) transient ischemia, 3) chronic multifocal ischemia, 4) subarachnoid/intracranial hemorrhage, and 5) sinus thrombosis. Global disease activity (Systemic Lupus Erythematosus Disease [SLE] Activity Index 2000), damage scores (SLE International Collaborating Clinics/American College of Rheumatology Damage Index), and Short Form 36 (SF-36) scores were collected. Time to event, linear and logistic regressions, and multistate models were used as appropriate. RESULTS: CerVEs were the fourth most frequent NP event: 82 of 1,826 patients had 109 events; of these events, 103 were attributed to SLE, and 44 were identified at the time of enrollment. The predominant events were stroke (60 of 109 patients) and transient ischemia (28 of 109 patients). CerVEs were associated with other NP events attributed to SLE, non-SLE-attributed NP events, African ancestry (at US SLICC sites), and increased organ damage scores. Lupus anticoagulant increased the risk of first stroke and sinus thrombosis and transient ischemic attack. Physician assessment indicated resolution or improvement in the majority of patients, but patients reported sustained reduction in SF-36 summary and subscale scores following a CerVE. CONCLUSION: CerVEs, the fourth most frequent NP event in SLE, are usually attributable to lupus. In contrast to good physician-reported outcomes, patients reported a sustained reduction in health-related quality of life following a CerVE.

15 Article Economic Evaluation of Lupus Nephritis in the Systemic Lupus International Collaborating Clinics Inception Cohort Using a Multistate Model Approach. 2018

Barber, Megan R W / Hanly, John G / Su, Li / Urowitz, Murray B / St Pierre, Yvan / Romero-Diaz, Juanita / Gordon, Caroline / Bae, Sang-Cheol / Bernatsky, Sasha / Wallace, Daniel J / Isenberg, David A / Rahman, Anisur / Ginzler, Ellen M / Petri, Michelle / Bruce, Ian N / Fortin, Paul R / Gladman, Dafna D / Sanchez-Guerrero, Jorge / Ramsey-Goldman, Rosalind / Khamashta, Munther A / Aranow, Cynthia / Mackay, Meggan / Alarcón, Graciela S / Manzi, Susan / Nived, Ola / Jönsen, Andreas / Zoma, Asad A / van Vollenhoven, Ronald F / Ramos-Casals, Manuel / Ruiz-Irastorza, Guillermo / Lim, S Sam / Kalunian, Kenneth C / Inanc, Murat / Kamen, Diane L / Peschken, Christine A / Jacobsen, Soren / Askanase, Anca / Theriault, Chris / Farewell, Vernon / Clarke, Ann E. ·University of Calgary, Alberta, Canada. · Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. · MRC Biostatistics Unit, University of Cambridge, Cambridge, UK. · Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada. · Research Institute of the McGill University Health Center, Montreal, Quebec, Canada. · Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico. · Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. · Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea. · McGill University Health Centre, Montreal, Quebec, Canada. · Cedars-Sinai/David Geffen School of Medicine at the University of California, Los Angeles. · University College London, London, UK. · State University of New York Downstate Medical Center, Brooklyn, New York. · Johns Hopkins University School of Medicine, Baltimore, Maryland. · Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, the University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. · CHU de Québec-Université Laval, Quebec City, Canada. · Northwestern University and Feinberg School of Medicine, Chicago, Illinois. · Lupus Research Unit, The Rayne Institute, St Thomas's Hospital, King's College London School of Medicine, London, UK. · Feinstein Institute for Medical Research, Manhasset, New York. · University of Alabama at Birmingham. · University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. · Lund University, Lund, Sweden. · Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK. · Karolinska Institute, Stockholm, Sweden. · Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain. · BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain. · Emory University School of Medicine, Atlanta, Georgia. · University of California Los Angeles School of Medicine, La Jolla. · Istanbul University, Istanbul, Turkey. · Medical University of South Carolina, Charleston. · University of Manitoba, Winnipeg, Manitoba, Canada. · Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. · Hospital for Joint Diseases, New York University Seligman Center for Advanced Therapeutics, New York, New York. ·Arthritis Care Res (Hoboken) · Pubmed #29193883.

ABSTRACT: OBJECTIVE: Little is known about the long-term costs of lupus nephritis (LN). The costs were compared between patients with and without LN using multistate modeling. METHODS: Patients from 32 centers in 11 countries were enrolled in the Systemic Lupus International Collaborating Clinics inception cohort within 15 months of diagnosis and provided annual data on renal function, hospitalizations, medications, dialysis, and selected procedures. LN was diagnosed by renal biopsy or the American College of Rheumatology classification criteria. Renal function was assessed annually using the estimated glomerular filtration rate (GFR) or estimated proteinuria. A multistate model was used to predict 10-year cumulative costs by multiplying annual costs associated with each renal state by the expected state duration. RESULTS: A total of 1,545 patients participated; 89.3% were women, the mean ± age at diagnosis was 35.2 ± 13.4 years, 49% were white, and the mean followup duration was 6.3 ± 3.3 years. LN developed in 39.4% of these patients by the end of followup. Ten-year cumulative costs were greater in those with LN and an estimated glomerular filtration rate (GFR) <30 ml/minute ($310,579 2015 Canadian dollars versus $19,987 if no LN and estimated GFR >60 ml/minute) or with LN and estimated proteinuria >3 gm/day ($84,040 versus $20,499 if no LN and estimated proteinuria <0.25 gm/day). CONCLUSION: Patients with estimated GFR <30 ml/minute incurred 10-year costs 15-fold higher than those with normal estimated GFR. By estimating the expected duration in each renal state and incorporating associated annual costs, disease severity at presentation can be used to anticipate future health care costs. This is critical knowledge for cost-effectiveness evaluations of novel therapies.

16 Article Breast cancer in systemic lupus erythematosus (SLE): receptor status and treatment. 2018

Chan, K / Clarke, A E / Ramsey-Goldman, R / Foulkes, W / Tessier Cloutier, B / Urowitz, M B / Gladman, D / Nived, O / Romero-Diaz, J / Petri, M / Ginzler, E / Fortin, P R / Bae, S C / Wallace, D J / Yelin, E H / Bernatsky, S. ·1 Faculty of Medicine, McGill University, Montreal, QC, Canada. · 2 Division of Rheumatology, University of Calgary, AB, Canada. · 3 Northwestern University and Feinberg School of Medicine, Chicago, IL, USA. · 4 Department of Human Genetics, McGill University, Montreal, QC, Canada. · 5 British Columbia Cancer Agency, Vancouver, BC, Canada. · 6 Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, ON, Canada. · 7 Department of Rheumatology, University Hospital Lund, Lund, Sweden. · 8 Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico. · 9 Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · 10 Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA. · 11 Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, QC, Canada. · 12 Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea. · 13 Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. · 14 Department of Medicine and Phillip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA. · 15 Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada. ·Lupus · Pubmed #28595511.

ABSTRACT: Objective There is a decreased risk of breast cancer in systemic lupus erythematosus (SLE) versus the general population; little is known regarding the receptor status of breast cancers in SLE, or treatment. Methods Breast cancer cases occurring after SLE diagnosis were ascertained through linkage with tumor registries. We determined breast cancer positivity for estrogen receptors (ER), progesterone receptors (PR), and/or Human Epidermal Growth Factor Receptor 2 (HER2), as well as cancer treatment. Results We obtained information on ER, PR, and/or HER2 status for 63 SLE patients with breast cancer. Fifty-three had information on ER and/or PR status; 36 of these (69%) were ER positive. Thirty-six of the 63 had information on HER2 status; of these, 26 had complete information on all three receptors. Twenty-one of these 26 (81%) were HER2 negative; seven of 26(27%) were triple negative. All but one patient underwent surgery; 11.5% received both non-tamoxifen chemotherapy and radiotherapy, 16.4% radiotherapy without non-tamoxifen chemotherapy, and 14.7% received non-tamoxifen chemotherapy without radiotherapy. Conclusion ER positivity was similar to historical general population figures, with a trend toward a higher proportion of triple-negative breast cancers in SLE (possibly reflecting the relatively young age of our SLE patients).

17 Article Study of Flare Assessment in Systemic Lupus Erythematosus Based on Paper Patients. 2018

Isenberg, D / Sturgess, J / Allen, E / Aranow, C / Askanase, A / Sang-Cheol, B / Bernatsky, S / Bruce, I / Buyon, J / Cervera, R / Clarke, A / Dooley, Mary Anne / Fortin, P / Ginzler, E / Gladman, D / Hanly, J / Inanc, M / Jacobsen, S / Kamen, D / Khamashta, M / Lim, S / Manzi, S / Nived, O / Peschken, C / Petri, M / Kalunian, K / Rahman, A / Ramsey-Goldman, R / Romero-Diaz, J / Ruiz-Irastorza, G / Sanchez-Guerrero, J / Steinsson, K / Sturfelt, G / Urowitz, M / van Vollenhoven, R / Wallace, D J / Zoma, A / Merrill, J / Gordon, C. ·University College London, London, UK. · The Hospital For Tropical Diseases, London, UK. · Feinstein Institute for Medical Research, Manhasset, New York. · Columbia University, New York, New York. · Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea. · McGill University, Quebec, Ontario, Canada. · The University of Manchester, Central Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK. · New York School of Medicine, New York. · Universitat de Barcelona, Barcelona, Spain. · Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. · University of North Carolina, Chapel Hill. · Université Laval, Quebec City, Québec, Canada. · Downstate Medical Center Rheumatology, Brooklyn, New York. · Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. · Nova Scotia Rehabiliation Center, Halifax, Nova Scotia, Canada. · Istanbul University, Istanbul, Turkey. · Rigshospitalet, Copenhagen, Denmark. · Medical University of South Carolina, Charleston, UK. · King's College London, London, UK. · Emory University, Atlanta, Georgia. · Allegheny Health Network, Pittsburgh, Pennsylvania. · Lund University, Lund, Sweden. · University of Manitoba, Winnipeg, Manitoba, Canada. · Johns Hopkins University, Baltimore, Maryland. · University of California at San Diego, Chicago, Illinois. · Northwestern University, Feinberg School of Medicine, Chicago, Illinois. · Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico. · Hospital Universitario Cruces and University of the Basque Country, Barakaldo, Spain. · Mount Sinai Hospital and University Health Network and University of Toronto, Toronto, Ontario, Canada. · Landspitali University Hospital, Reykjavik, Iceland. · Karolinska University Hospital, Solna, Sweden. · University of California at Los Angeles, Scotland, UK. · Hairmyres Hospital, East Kilbride, Scotland, UK. · Oklahoma Medical Research Foundation, Oklahoma City, UK. · College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. ·Arthritis Care Res (Hoboken) · Pubmed #28388813.

ABSTRACT: OBJECTIVE: To determine the level of agreement of disease flare severity (distinguishing severe, moderate, and mild flare and persistent disease activity) in a large paper-patient exercise involving 988 individual cases of systemic lupus erythematosus. METHODS: A total of 988 individual lupus case histories were assessed by 3 individual physicians. Complete agreement about the degree of flare (or persistent disease activity) was obtained in 451 cases (46%), and these provided the reference standard for the second part of the study. This component used 3 flare activity instruments (the British Isles Lupus Assessment Group [BILAG] 2004, Safety of Estrogens in Lupus Erythematosus National Assessment [SELENA] flare index [SFI] and the revised SELENA flare index [rSFI]). The 451 patient case histories were distributed to 18 pairs of physicians, carefully randomized in a manner designed to ensure a fair case mix and equal distribution of flare according to severity. RESULTS: The 3-physician assessment of flare matched the level of flare using the 3 indices, with 67% for BILAG 2004, 72% for SFI, and 70% for rSFI. The corresponding weighted kappa coefficients for each instrument were 0.82, 0.59, and 0.74, respectively. We undertook a detailed analysis of the discrepant cases and several factors emerged, including a tendency to score moderate flares as severe and persistent activity as flare, especially when the SFI and rSFI instruments were used. Overscoring was also driven by scoring treatment change as flare, even if there were no new or worsening clinical features. CONCLUSION: Given the complexity of assessing lupus flare, we were encouraged by the overall results reported. However, the problem of capturing lupus flare accurately is not completely solved.

18 Article Risk of Allergic Conditions in Children Born to Women With Systemic Lupus Erythematosus. 2018

Couture, Julie / Ben-Shoshan, Moshe / Pineau, Christian A / Scott, Susan / Clarke, Ann E / Bernatsky, Sasha / Vinet, Evelyne. ·McGill University Health Centre, Montreal, Quebec, Canada. · University of Calgary, Calgary, Alberta, Canada. ·Arthritis Care Res (Hoboken) · Pubmed #28382783.

ABSTRACT: OBJECTIVE: Limited evidence suggests a potentially increased risk of allergic conditions in offspring born to women with systemic lupus erythematosus (SLE). In a large population-based study, we aimed to determine if children born to mothers with SLE have an increased risk of allergic conditions compared to children born to mothers without SLE. METHODS: Using the Offspring of SLE Mothers Registry, we identified children born live to mothers with SLE and their matched controls, and ascertained the number of allergic conditions (asthma, allergic rhinitis, eczema, urticaria, angioedema, and anaphylaxis) based on ≥1 hospitalization or ≥1 or 2 physician(s) visit(s) with a relevant diagnostic code. We adjusted for maternal age, education, race/ethnicity, obstetrics complications, calendar year of birth, sex of the child, and maternal medication. RESULTS: There were 509 women with SLE who had 719 children, while 5,824 matched controls had 8,493 children. The mean ± SD followup period was 9.1 ± 5.8 years. Compared to controls, more children born to mothers with SLE had evidence of allergic conditions (43.9% [95% confidence interval (95% CI) 40.4-47.6] versus 38.1% [95% CI 37.0-39.1]). In multivariate analysis (n = 9,212), children born to mothers with SLE had an increased risk of allergic conditions versus control children (odds ratio 1.35 [95% CI 1.13-1.61]). CONCLUSION: Compared to children from the general population, children born to women with SLE may have an increased risk of allergic conditions. Genetics, shared environmental exposures, as well as in utero exposure to maternal autoantibodies and cytokines may mediate this increased risk.

19 Article Nitrated nucleosome levels and neuropsychiatric events in systemic lupus erythematosus; a multi-center retrospective case-control study. 2017

Ferreira, Isabel / Croca, Sara / Raimondo, Maria Gabriella / Matharu, Manjit / Miller, Sarah / Giles, Ian / Isenberg, David / Ioannou, Yiannis / Hanly, John G / Urowitz, Murray B / Anderson, Nicole / Aranow, Cynthia / Askanase, Anca / Bae, Sang-Cheol / Bernatsky, Sasha / Bruce, Ian N / Buyon, Jill / Clarke, Ann E / Dooley, Mary Anne / Fortin, Paul / Ginzler, Ellen / Gladman, Dafna / Gordon, Caroline / Inanc, Murat / Jacobsen, Søren / Kalunian, Kenneth / Kamen, Diane / Khamashta, Munther / Lim, Sam / Manzi, Susan / Merrill, Joan / Nived, Ola / Peschken, Christine / Petri, Michelle / Ramsey-Goldman, Rosalind / Ruiz-Irastorza, Guillermo / Sanchez-Guerrero, Jorge / Steinson, Kristjan / Sturfelt, Gunnar K / van Vollenhoven, Ronald / Wallace, Daniel J / Zoma, Asad / Rahman, Anisur. ·Centre for Rheumatology Research, University College London, Fourth Floor Rayne Institute, 5 University Street, London, WC1E 6JF, UK. · Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. · Arthritis Research UK Centre for Adolescent Rheumatology, UCL/UCLH/Great Ormond Street Hospital, London, UK. · Division of Rheumatology, Dalhousie University and Queen Elizabeth II Health Sciences Center, Halifax, NS, Canada. · Lupus Program, Centre for Prognosis Studies in The Rheumatic Disease and Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada. · Feinstein Institute for Medical Research, Manhasset, NY, USA. · Rheumatology, Columbia University, New York, NY, USA. · Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea. · Divisions of Clinical Epidemiology and Rheumatology, McGill University Health Centre, Montreal, QC, Canada. · Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. · New York School of Medicine, New York, NY, USA. · Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. · Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA. · Centre Hospitalier de l'Université Laval (CHUL), Québec, QC, Canada. · Downstate Medical Center Rheumatology, Brooklyn, New York, NY, USA. · Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. · Department of Internal Medicine, Istanbul University, Istanbul, Turkey. · Copenhagen Lupus and Vasculitis Clinic, Centre For Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark. · University of California, San Diego, La Jolla, CA, USA. · Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, SC, USA. · FRCP Division of Women's Health, King's College, London, UK. · Department of Medicine, Emory University, Atlanta, GA, USA. · Allegheny Health Network, Pittsburgh, PA, USA. · Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA. · Department of Rheumatology, Lund University, Lund, Sweden. · Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. · Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Northwestern University, Feinberg School of Medicine, Chicago, IL, USA. · Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute. Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Bizkaia, Spain. · Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada. · Department of Rheumatology, Landspitali University Hospital, Reykjavik, Iceland. · Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Sweden. · Cedars-Sinai Medical Center/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. · Department of Rheumatology Hairmyres Hospital, East Kilbride, Scotland, UK. · Centre for Rheumatology Research, University College London, Fourth Floor Rayne Institute, 5 University Street, London, WC1E 6JF, UK. anisur.rahman@ucl.ac.uk. ·Arthritis Res Ther · Pubmed #29273092.

ABSTRACT: BACKGROUND: In patients with systemic lupus erythematosus (SLE) there is no serological test that will reliably distinguish neuropsychiatric (NP) events due to active SLE from those due to other causes. Previously we showed that serum levels of nitrated nucleosomes (NN) were elevated in a small number of patients with NPSLE. Here we measured serum NN in samples from a larger population of patients with SLE and NP events to see whether elevated serum NN could be a marker for NPSLE. METHODS: We obtained serum samples from patients in the Systemic Lupus International Collaborative Clinics (SLICC) inception cohort. This included 216 patients with NP events and two matched controls with SLE but no NP events for each of these patients. For the NP patients we tested samples taken before, during and after the NP event. RESULTS: Twenty-six patients had events attributed to SLE according to the most stringent SLICC attribution rule. In these patients there was no association between onset of event and elevated serum NN. In 190 patients in whom events were not attributed to SLE by the SLICC rules, median serum NN was elevated at the onset of event (P = 0.006). The predominant clinical features in this group of 190 patients were headache, mood disorders and anxiety. CONCLUSIONS: Serum NN levels rise at the time of an NP event in a proportion of patients with SLE. Further studies are needed to determine the value of serum NN as a biomarker for NPSLE.

20 Article Comment on: Cumulative immunosuppressant exposure is associated with diversified cancer risk among 14 832 patients with systemic lupus erythematosus. 2017

Bernatsky, Sasha / Clarke, Ann E / Ramsey-Goldman, Rosalind. ·Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, QC. · Division of Rheumatology, University of Calgary, Calgary, Alberta, Canada. · Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. ·Rheumatology (Oxford) · Pubmed #28957560.

ABSTRACT: -- No abstract --

21 Article Malignancy in Pediatric-onset Systemic Lupus Erythematosus. 2017

Bernatsky, Sasha / Clarke, Ann E / Zahedi Niaki, Omid / Labrecque, Jeremy / Schanberg, Laura E / Silverman, Earl D / Hayward, Kristen / Imundo, Lisa / Brunner, Hermine I / Haines, Kathleen A / Cron, Randy Q / Oen, Kiem / Wagner-Weiner, Linda / Rosenberg, Alan M / O'Neil, Kathleen M / Duffy, Ciarán M / von Scheven, Emily / Joseph, Lawrence / Lee, Jennifer L / Ramsey-Goldman, Rosalind. ·From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA. sasha.bernatsky@mcgill.ca. · S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine. sasha.bernatsky@mcgill.ca. · From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA. · S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine. ·J Rheumatol · Pubmed #28765255.

ABSTRACT: OBJECTIVE: To determine cancer incidence in a large pediatric-onset systemic lupus erythematosus (SLE) population. METHODS: Data were examined from 12 pediatric SLE registries in North America. Patients were linked to their regional cancer registries to detect cancers observed after cohort entry, defined as date first seen in the clinic. The expected number of malignancies was obtained by multiplying the person-years in the cohort (defined from cohort entry to end of followup) by the geographically matched age-, sex-, and calendar year-specific cancer rates. The standardized incidence ratio (SIR; ratio of cancers observed to expected) was generated, with 95% CI. RESULTS: A total of 1168 patients were identified from the registries. The mean age at cohort entry was 13 years (SD 3.3), and 83.7% of the subjects were female. The mean duration of followup was 7.6 years, resulting in a total observation period of 8839 years spanning the calendar period 1974-2009. During followup, fourteen invasive cancers occurred (1.6 cancers per 1000 person-yrs, SIR 4.13, 95% CI 2.26-6.93). Three of these were hematologic (all lymphomas), resulting in an SIR for hematologic cancers of 4.68 (95% CI 0.96-13.67). SIR were increased for both male and female patients, and across age groups. CONCLUSION: Although cancer remains a relatively rare outcome in pediatric-onset SLE, our data do suggest an increase in cancer for patients followed an average of 7.6 years. About one-fifth of the cancers were hematologic. Longer followup, and study of drug effects and disease activity, is warranted.

22 Article The prevalence and determinants of anti-DFS70 autoantibodies in an international inception cohort of systemic lupus erythematosus patients. 2017

Choi, M Y / Clarke, A E / St Pierre, Y / Hanly, J G / Urowitz, M B / Romero-Diaz, J / Gordon, C / Bae, S-C / Bernatsky, S / Wallace, D J / Merrill, J T / Isenberg, D A / Rahman, A / Ginzler, E M / Petri, M / Bruce, I N / Dooley, M A / Fortin, P / Gladman, D D / Sanchez-Guerrero, J / Steinsson, K / Ramsey-Goldman, R / Khamashta, M A / Aranow, C / Alarcón, G S / Manzi, S / Nived, O / Zoma, A A / van Vollenhoven, R F / Ramos-Casals, M / Ruiz-Irastorza, G / Lim, S S / Kalunian, K C / Inanc, M / Kamen, D L / Peschken, C A / Jacobsen, S / Askanase, A / Buyon, J / Mahler, M / Fritzler, M J. ·1 University of Calgary, Cumming School of Medicine. · 2 Research Institute of the McGill University Health Centre. · 3 Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. · 4 Lupus Program, Centre for Prognosis Studies in The Rheumatic Disease and Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. · 5 Instituto Nacional de CienciasMédicas y Nutrición, Mexico City, Mexico. · 6 Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. · 7 Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea. · 8 Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre. · 9 Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. · 10 Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA. · 11 Centre for Rheumatology, Department of Medicine, University College London, UK. · 12 Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA. · 13 Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · 14 Arthritis Research UKCentre for Epidemiology, Centre for Musculoskeletal Research, The University of Manchester; and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre; Manchester, UK. · 15 Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA. · 16 Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Québec City, Canada. · 17 Mount Sinai Hospital and University Health Network, University of Toronto, Canada. · 18 Center for Rheumatology Research, Landspitali University hospital, Reykjavik, Iceland. · 19 Northwestern University and Feinberg School of Medicine, Chicago, IL, USA. · 20 Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, UK, London, UK. · 21 Feinstein Institute for Medical Research, Manhasset, NY, USA. · 22 Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. · 23 Allegheny Health Network, Pittsburgh Pennsylvania. · 24 Department of Rheumatology, University Hospital Lund, Lund, Sweden. · 25 Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland UK. · 26 Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm, Sweden. · 27 Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain. · 28 Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain. · 29 Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia, USA. · 30 UCSD School of Medicine, La Jolla, CA, USA. · 31 Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. · 32 Medical University of South Carolina, Charleston, South Carolina, USA. · 33 University of Manitoba, Winnipeg, Manitoba, Canada. · 34 Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark. · 35 Hospital for Joint Diseases, NYU, Seligman Centre for Advanced Therapeutics, New York NY. · 36 New York School of Medicine, New York, US. · 37 Inova Diagnostics Inc., San Diego, CA, USA. ·Lupus · Pubmed #28420054.

ABSTRACT: Autoantibodies to dense fine speckles 70 (DFS70) are purported to rule out the diagnosis of SLE when they occur in the absence of other SLE-related autoantibodies. This study is the first to report the prevalence of anti-DFS70 in an early, multinational inception SLE cohort and examine demographic, clinical, and autoantibody associations. Patients were enrolled in the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort within 15 months of diagnosis. The association between anti-DFS70 and multiple parameters in 1137 patients was assessed using univariate and multivariate logistic regression. The frequency of anti-DFS70 was 7.1% (95% CI: 5.7-8.8%), while only 1.1% (95% CI: 0.6-1.9%) were monospecific for anti-DFS70. In multivariate analysis, patients with musculoskeletal activity (Odds Ratio (OR) 1.24 [95% CI: 1.10, 1.41]) or with anti-β2 glycoprotein 1 (OR 2.17 [95% CI: 1.22, 3.87]) were more likely and patients with anti-dsDNA (OR 0.53 [95% CI: 0.31, 0.92]) or anti-SSB/La (OR 0.25 [95% CI: 0.08, 0.81]) were less likely to have anti-DFS70. In this study, the prevalence of anti-DFS70 was higher than the range previously published for adult SLE (7.1 versus 0-2.8%) and was associated with musculoskeletal activity and anti-β2 glycoprotein 1 autoantibodies. However, 'monospecific' anti-DFS70 autoantibodies were rare (1.1%) and therefore may be helpful to discriminate between ANA-positive healthy individuals and SLE.

23 Article Novel insights into systemic autoimmune rheumatic diseases using shared molecular signatures and an integrative analysis. 2017

Hudson, Marie / Bernatsky, Sasha / Colmegna, Ines / Lora, Maximilien / Pastinen, Tomi / Klein Oros, Kathleen / Greenwood, Celia M T. ·a Lady Davis Research Institute , Montréal , QC , Canada. · b Division of Rheumatology , Jewish General Hospital , Montréal , QC , Canada. · c Department of Medicine , McGill University , Montréal , QC , Canada. · d The Research Institute of the McGill University Health Centre , Montréal , QC , Canada. · e McGill University and Genome Quebec Innovation Centre , McGill University , Montréal , QC , Canada. · f Department of Human Genetics , McGill University , Montréal , QC , Canada. · g Department of Oncology , McGill University , Montréal , QC , Canada. · h Department of Epidemiology , Biostatistics & Occupational Health, McGill University , Montréal , QC , Canada. ·Epigenetics · Pubmed #28387599.

ABSTRACT: We undertook this study to identify DNA methylation signatures of three systemic autoimmune rheumatic diseases (SARDs), namely rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis, compared to healthy controls. Using a careful design to minimize confounding, we restricted our study to subjects with incident disease and performed our analyses on purified CD4

24 Article Multiple signals at the extended 8p23 locus are associated with susceptibility to systemic lupus erythematosus. 2017

Demirci, F Yesim / Wang, Xingbin / Morris, David L / Feingold, Eleanor / Bernatsky, Sasha / Pineau, Christian / Clarke, Ann / Ramsey-Goldman, Rosalind / Manzi, Susan / Vyse, Timothy J / Kamboh, M I. ·Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA. · Department of Medical & Molecular Genetics, King's College London, Guy's Hospital, London, UK. · Division of Rheumatology, Department of Medicine, McGill University, Montreal, Canada. · Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Canada. · Division of Rheumatology, Feinberg School of Medicine, Northwestern University, Chicago, USA. · Department of Medicine, Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, USA. ·J Med Genet · Pubmed #28289186.

ABSTRACT: BACKGROUND: A major systemic lupus erythematosus (SLE) susceptibility locus lies within a common inversion polymorphism region (encompassing 3.8 - 4.5  Mb) located at 8p23. Initially implicated genes included OBJECTIVE AND METHODS: In this case -control study, we further investigated the 'extended' 8p23 locus (~ 4  Mb) where we observed multiple SLE signals and assessed these signals for their relation to the inversion affecting this region. The study involved a North American discovery data set ( RESULTS: Meta-analysis of 8p23 SNPs, with p < 0.05 in both data sets, identified 51 genome-wide significant SNPs (p < 5.0 × 10 CONCLUSIONS: Our results implicate multiple (known+novel) SLE signals/genes at the extended 8p23 locus, beyond previously reported signals/genes, and suggest that this broad locus contributes to SLE risk through the effects of multiple genes/pathways.

25 Article Disease characterization of systemic lupus erythematosus (SLE) patients in Quebec. 2017

Ng, R / Bernatsky, S / Rahme, E. ·1 Research Institute of the McGill University Health Centre, Medicine, Montreal, Canada. · 2 Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Medicine - Rheumatology, Montreal, Canada. · 3 McGill University Health Centre, Clinical Epidemiology, Montreal, Canada. ·Lupus · Pubmed #28178878.

ABSTRACT: Objective Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by an array of organ manifestations that can appear during flares and disappear during remissions. The objectives of this study were: (i) to examine SLE manifestation groups longitudinally in an SLE cohort; and (ii) to assess the association between early antimalarial treatment and renal manifestations. Methods Seven SLE manifestation groups-cutaneous, hematologic, lung, musculoskeletal, neuropsychiatric, serositis, renal-were tracked using Kaplan-Meier survival curves in an incident SLE cohort from Quebec health administrative data ( n = 2010). A subgroup with provincial drug insurance coverage was followed over time to examine the association between early antimalarial treatment (within three months after SLE diagnosis) and renal manifestations using a Cox proportional hazards survival model. Results Cutaneous manifestations was the most common manifestation at SLE diagnosis (30.0%, 95% CI: 27.7-32.2%). About two-thirds (66.2%, 95% CI: 63.4-68.9%) of patients had evidence of at least one SLE manifestation at diagnosis, which increased to 87.2% (95% CI: 84.2-90.3%) by the end of follow-up. After adjusting for age, sex, early concomitant systemic steroid therapy, Charlson comorbidity index, primary care visits in the year prior and other SLE manifestations at baseline, no statistically significant association was established between antimalarial therapy and renal manifestations. Conclusion This study provides insight regarding organ manifestations within a population-based sample. Most patients identified with SLE had other diagnostic evidence that supports an underlying diagnosis of SLE. No protective effects for antimalarial agents against renal manifestations could be established in this population-based cohort.

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