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Systemic Lupus Erythematosus: HELP
Articles by Murat Inanc
Based on 27 articles published since 2008
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Between 2008 and 2019, M. Inanç wrote the following 27 articles about Lupus Erythematosus, Systemic.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. 2014

van Vollenhoven, Ronald F / Mosca, Marta / Bertsias, George / Isenberg, David / Kuhn, Annegret / Lerstrøm, Kirsten / Aringer, Martin / Bootsma, Hendrika / Boumpas, Dimitrios / Bruce, Ian N / Cervera, Ricard / Clarke, Ann / Costedoat-Chalumeau, Nathalie / Czirják, László / Derksen, Ronald / Dörner, Thomas / Gordon, Caroline / Graninger, Winfried / Houssiau, Frédéric / Inanc, Murat / Jacobsen, Søren / Jayne, David / Jedryka-Goral, Anna / Levitsky, Adrian / Levy, Roger / Mariette, Xavier / Morand, Eric / Navarra, Sandra / Neumann, Irmgard / Rahman, Anisur / Rovensky, Jozef / Smolen, Josef / Vasconcelos, Carlos / Voskuyl, Alexandre / Voss, Anne / Zakharova, Helena / Zoma, Asad / Schneider, Matthias. ·Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases, Stockholm, Sweden, Karolinska Institutet, , Stockholm, Sweden. ·Ann Rheum Dis · Pubmed #24739325.

ABSTRACT: The principle of treating-to-target has been successfully applied to many diseases outside rheumatology and more recently to rheumatoid arthritis. Identifying appropriate therapeutic targets and pursuing these systematically has led to improved care for patients with these diseases and useful guidance for healthcare providers and administrators. Thus, an initiative to evaluate possible therapeutic targets and develop treat-to-target guidance was believed to be highly appropriate in the management of systemic lupus erythematosus (SLE) patients as well. Specialists in rheumatology, nephrology, dermatology, internal medicine and clinical immunology, and a patient representative, contributed to this initiative. The majority convened on three occasions in 2012-2013. Twelve topics of critical importance were identified and a systematic literature review was performed. The results were condensed and reformulated as recommendations, discussed, modified and voted upon. The finalised bullet points were analysed for degree of agreement among the task force. The Oxford Centre level of evidence (LoE, corresponding to the research questions) and grade of recommendation (GoR) were determined for each recommendation. The 12 systematic literature searches and their summaries led to 11 recommendations. Prominent features of these recommendations are targeting remission, preventing damage and improving quality of life. LoE and GoR of the recommendations were variable but agreement was >0.9 in each case. An extensive research agenda was identified, and four overarching principles were also agreed upon. Treat-to-target-in-SLE (T2T/SLE) recommendations were developed by a large task force of multispecialty experts and a patient representative. It is anticipated that 'treating-to-target' can and will be applicable to the care of patients with SLE.

2 Review A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS). 2017

van Vollenhoven, Ronald / Voskuyl, Alexandre / Bertsias, George / Aranow, Cynthia / Aringer, Martin / Arnaud, Laurent / Askanase, Anca / Balážová, Petra / Bonfa, Eloisa / Bootsma, Hendrika / Boumpas, Dimitrios / Bruce, Ian / Cervera, Ricard / Clarke, Ann / Coney, Cindy / Costedoat-Chalumeau, Nathalie / Czirják, László / Derksen, Ronald / Doria, Andrea / Dörner, Thomas / Fischer-Betz, Rebecca / Fritsch-Stork, Ruth / Gordon, Caroline / Graninger, Winfried / Györi, Noémi / Houssiau, Frédéric / Isenberg, David / Jacobsen, Soren / Jayne, David / Kuhn, Annegret / Le Guern, Veronique / Lerstrøm, Kirsten / Levy, Roger / Machado-Ribeiro, Francinne / Mariette, Xavier / Missaykeh, Jamil / Morand, Eric / Mosca, Marta / Inanc, Murat / Navarra, Sandra / Neumann, Irmgard / Olesinska, Marzena / Petri, Michelle / Rahman, Anisur / Rekvig, Ole Petter / Rovensky, Jozef / Shoenfeld, Yehuda / Smolen, Josef / Tincani, Angela / Urowitz, Murray / van Leeuw, Bernadette / Vasconcelos, Carlos / Voss, Anne / Werth, Victoria P / Zakharova, Helena / Zoma, Asad / Schneider, Matthias / Ward, Michael. ·Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institutet, D1:00 Karolinska University Hospital, Solna, Stockholm, Sweden. · Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands. · Department of Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Iraklion, Greece. · Feinstein Institute for Medical Research, Manhasset, New York, USA. · Department of Medicine III, University Medical Center TU Dresden, Dresden, Germany. · New York University, New York, USA. · LPRe SR-Klub Motýlik, Bratislava, Slovakia. · Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. · Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. · Department of Medicine and Joint Academic Rheumatology Program Medical School, National and Kapodestrian University of Athens, Athens, Greece. · NIHR Manchester Biomedical Research Unit, The University of Manchester and Central Manchester Foundation Trust, Manchester, UK. · Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain. · Division of Rheumatology, The Arthritis Society Chair in Rheumatic Diseases Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada. · Lupus Foundation of America, Washington DC, USA. · Université Paris-Decartes, Paris, France. · AP-HP, Hôpital Cochin, service de médecine interne, centre de reference maladies auto-immunes et systémiques rares, Paris, France. · Department of Rheumatology and Immunology, Institute of Bioanalysis, Institute of Family Medicine, University of Pécs, Pécs, Hungary. · Third Department of Internal Medicine, Semmelweis University, Budapest, Hungary. · Department Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands. · Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy. · Department Medicine/Rheumatology and Clinical Immunology, Charite Universitätsmedizin Berlin, Berlin, Germany. · Polyclinic of Rheumatology, Hiller Research Unit, University Clinic Duesseldorf, Heinrich-Heine-University, Duesseldorf, Germany. · Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. · Division of Rheumatology, Medical University of Graz, Graz, Austria. · Service de Rhumatologie, Cliniques universitaires Saint-Luc, Pôle de pathologies rhumatismales inflammatoires et systémiques, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Bruxelles, Belgium. · Department of Medicine, The Centre for Rheumatology, University College London, UK. · Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen, Denmark. · Department of Medicine, University of Cambridge, Cambridge, UK. · Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center Mainz, Mainz, Germany. · LUPUS EUROPE, co-opted trustee for research, Essex UK. · Rheumatology Department, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. · Université Paris-Sud; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-sud; INSERM U1184, Le Kremlin Bicêtre, France. · Bone Densitometry Unit, Monla Hospital, Tripoli, Lebanon. · Monash University, Faculty of Medicine, Nursing & Health Sciences, Monash Medical Centre, Clayton, Australia. · Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. · Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey. · University of Santo Tomas, Manila, Philippines. · Vasculitis.at, Vienna, Austria. · Department of Connective Tissues Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland. · Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · RNA and Molecular Pathology Research Group, Institute of Medical Biology, Health Science Faculty, University of Tromsø, Tromsø, Norway. · National Institute for Rheumatic Diseases, Piešťany, Slovak Republic. · Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center (Affiliated to Tel-Aviv University), Tel-Aviv, Israel. · Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria. · 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria. · Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, U.O. Reumatologia e Immunolgia Clinica, Spedali Civili di Brescia, Brescia, Italy. · Centre for Prognosis Studies in the Rheumatic Diseases, Senior Scientist Krembil Research Institute, Professor Medicine, University of Toronto, Toronto Western Hospital EW 1-409, Toronto, Canada. · Unidade de Imunologia Clínica, Hospital Santo António, Centro Hospitalar do Porto, UMIB, Instituto de Ciencias Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal. · Department of Rheumatology, Odense University Hospital, University of Southern Denmark, Denmark. · Corporal Michael J. Crescenz VA Medical Center (Philadelphia), Philadelphia, Philadelphia, USA. · Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. · Nephrology Unit, City Clinical Hospital n.a. S.P. Botkin, Moscow, Russia. · Lanarkshire Centre for Rheumatology, Hairmyres Hospital, Scotland, UK. · National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA. ·Ann Rheum Dis · Pubmed #27884822.

ABSTRACT: OBJECTIVES: Treat-to-target recommendations have identified 'remission' as a target in systemic lupus erythematosus (SLE), but recognise that there is no universally accepted definition for this. Therefore, we initiated a process to achieve consensus on potential definitions for remission in SLE. METHODS: An international task force of 60 specialists and patient representatives participated in preparatory exercises, a face-to-face meeting and follow-up electronic voting. The level for agreement was set at 90%. RESULTS: The task force agreed on eight key statements regarding remission in SLE and three principles to guide the further development of remission definitions:1. Definitions of remission will be worded as follows: CONCLUSIONS: The work of this international task force provides a framework for testing different definitions of remission against long-term outcomes.

3 Article Increased serum leptin levels are associated with metabolic syndrome and carotid intima media thickness in premenopausal systemic lupus erythematosus patients without clinical atherosclerotic vascular events. 2018

Demir, S / Erten, G / Artım-Esen, B / Şahinkaya, Y / Pehlivan, Ö / Alpay-Kanıtez, N / Deniz, G / Inanç, M. ·1 Department of Internal Medicine, Istanbul University, Istanbul, Turkey. · 2 Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey. ·Lupus · Pubmed #29954279.

ABSTRACT: Aim To assess subclinical atherosclerosis and the role of inflammatory mediators, vascular endothelial cell activation markers and adipocytokines in systemic lupus erythematosus (SLE) in the presence or absence of metabolic syndrome (MetS). Methods We studied 66 premenopausal female SLE patients (20 with MetS) and 28 female healthy controls (HCs) without history of cardiovascular disease (CVD). Subclinical atherosclerosis was screened by measuring carotid intima media thickness (CIMT). Serum levels of high sensitivity C-reactive protein (hs-CRP), tumour necrosis factor α (TNFα), interleukin 6 (IL-6), soluble intercellular adhesion molecule 1 (sICAM-1), soluble E-selectin, leptin and visfatin were measured. Results The mean age of MetS

4 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.

5 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.

6 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.

7 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.

8 Article Comparison of Disease Characteristics, Organ Damage, and Survival in Patients with Juvenile-onset and Adult-onset Systemic Lupus Erythematosus in a Combined Cohort from 2 Tertiary Centers in Turkey. 2017

Artim-Esen, Bahar / Şahin, Sezgin / Çene, Erhan / Şahinkaya, Yasemin / Barut, Kenan / Adrovic, Amra / Özlük, Yasemin / Kılıçaslan, Işın / Omma, Ahmet / Gül, Ahmet / Öcal, Lale / Kasapçopur, Özgür / İnanç, Murat. ·From the Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University; Division of Rheumatology, Department of Pediatrics, Cerrahpaşa Faculty of Medicine, Istanbul University; Department of Statistics, Faculty of Arts and Sciences, Yıldız Technical University; Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. bahar.artimesen@istanbul.edu.tr bahartimesen@gmail.com. · B. Artim-Esen, MD, Associate Professor, Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University; S. Şahin, MD, Fellow, Division of Rheumatology, Department of Pediatrics, Cerrahpaşa Faculty of Medicine, Istanbul University; E. Çene, Research Assistant, Department of Statistics, Faculty of Arts and Sciences, Yıldız Technical University; Y. Şahinkaya*, MD, Fellow, Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University; K. Barut, MD, Fellow, Division of Rheumatology, Department of Pediatrics, Cerrahpaşa Faculty of Medicine, Istanbul University; A. Adrovic, MD, Fellow, Division of Rheumatology, Department of Pediatrics, Cerrahpaşa Faculty of Medicine; Y. Özlük, PhD, Associate professor, Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, I. Kılıçaslan, PhD, Professor, Department of Pathology, Istanbul Faculty of Medicine, Istanbul University; A. Omma**, MD, Fellow, Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University; A. Gül, MD, Professor, Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine; L. Öcal, MD, Professor, Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University; Ö. Kasapçopur, MD, Professor, Division of Rheumatology, Department of Pediatrics, Cerrahpaşa Faculty of Medicine, Istanbul University; M. İnanç, MD, Professor, Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University. bahar.artimesen@istanbul.edu.tr bahartimesen@gmail.com. · From the Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University; Division of Rheumatology, Department of Pediatrics, Cerrahpaşa Faculty of Medicine, Istanbul University; Department of Statistics, Faculty of Arts and Sciences, Yıldız Technical University; Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. · B. Artim-Esen, MD, Associate Professor, Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University; S. Şahin, MD, Fellow, Division of Rheumatology, Department of Pediatrics, Cerrahpaşa Faculty of Medicine, Istanbul University; E. Çene, Research Assistant, Department of Statistics, Faculty of Arts and Sciences, Yıldız Technical University; Y. Şahinkaya*, MD, Fellow, Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University; K. Barut, MD, Fellow, Division of Rheumatology, Department of Pediatrics, Cerrahpaşa Faculty of Medicine, Istanbul University; A. Adrovic, MD, Fellow, Division of Rheumatology, Department of Pediatrics, Cerrahpaşa Faculty of Medicine; Y. Özlük, PhD, Associate professor, Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, I. Kılıçaslan, PhD, Professor, Department of Pathology, Istanbul Faculty of Medicine, Istanbul University; A. Omma**, MD, Fellow, Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University; A. Gül, MD, Professor, Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine; L. Öcal, MD, Professor, Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University; Ö. Kasapçopur, MD, Professor, Division of Rheumatology, Department of Pediatrics, Cerrahpaşa Faculty of Medicine, Istanbul University; M. İnanç, MD, Professor, Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University. ·J Rheumatol · Pubmed #28298568.

ABSTRACT: OBJECTIVE: Age at onset has been shown to affect the clinical course and outcome of systemic lupus erythematosus (SLE). Herein, we aimed to define the differences in clinical characteristics, organ damage, and survival between patients with juvenile-onset (jSLE) and adult-onset SLE (aSLE). METHODS: For the study, 719 patients (76.9%) with aSLE and 216 (23.1%) with jSLE were examined. Comparisons between the groups were made for demographic characteristics, clinical features, auto-antibody profiles, damage, and survival rates. RESULTS: These results were significantly more frequent in jSLE: photosensitivity, malar rash, oral ulcers, renal involvement, neuropsychiatric (NP) manifestations, and autoimmune hemolytic anemia (AIHA). Of the autoantibodies, a higher frequency of anti-dsDNA and anticardiolipin IgG and IgM were observed in the jSLE group. A significant proportion of patients with aSLE had anti-Sm positivity and pleuritis. The proportion of patients with jSLE who developed organ damage was comparable to that of patients with aSLE (53% vs 47%) and the mean damage scores were similar in both groups. Renal damage was significantly more frequent in jSLE while musculoskeletal and cardiovascular system damage and diabetes mellitus were more prominent in aSLE. Comparison of survival rates of the 2 groups did not reveal any significant differences. CONCLUSION: We report a higher frequency in the jSLE group of renal involvement, cutaneous symptoms, oral ulcers, NP manifestations, AIHA, and anti-dsDNA positivity. A significant proportion of patients in the jSLE group had damage, most prominently in the renal domain. Our findings might support different genetic/environmental backgrounds for these 2 subgroups.

9 Article A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach. 2016

Hanly, John G / Su, Li / Urowitz, Murray B / Romero-Diaz, Juanita / Gordon, Caroline / Bae, Sang-Cheol / Bernatsky, Sasha / Clarke, Ann E / Wallace, Daniel J / Merrill, Joan T / Isenberg, David A / Rahman, Anisur / Ginzler, Ellen M / Petri, Michelle / Bruce, Ian N / Dooley, M A / Fortin, Paul / Gladman, Dafna D / Sanchez-Guerrero, Jorge / Steinsson, Kristjan / Ramsey-Goldman, Rosalind / Khamashta, Munther A / Aranow, Cynthia / Alarcón, Graciela S / Fessler, Barri J / Manzi, Susan / Nived, Ola / Sturfelt, Gunnar K / 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. ·Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. · Institute of Public Health and University of Cambridge, University Forvie Site, Cambridge, UK. · Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada. · Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico. · University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK. · Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea. · McGill University Health Centre, Montreal, Quebec, Canada. · University of Calgary, Calgary, Alberta, Canada. · Cedars-Sinai Medical Center and University of California, Los Angeles, David Geffen School of Medicine. · Oklahoma Medical Research Foundation, Oklahoma City. · University College London, London, UK. · State University of New York Downstate Medical Center, Brooklyn. · Johns Hopkins University School of Medicine, Baltimore, Maryland. · Arthritis Research UK Epidemiology Unit, Manchester Academic Health Sciences Centre, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, and Manchester Academic Health Science Centre, Manchester, UK. · University of North Carolina, Chapel Hill. · Centre Hospitalier Universitaire de Québec and Université Laval, Quebec City, Canada. · Landspitali University Hospital, Reykjavik, Iceland. · Northwestern University Feinberg School of Medicine, Chicago, Illinois. · The Rayne Institute, St Thomas' 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. · University Hospital Lund, Lund, Sweden. · Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK. · Karolinska Institute, Stockholm, Sweden. · Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, 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 at San Diego, La Jolla. · Istanbul University, Istanbul, Turkey. · Medical University of South Carolina, Charleston. · University of Manitoba, Winnipeg, Manitoba, Canada. · Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. · Hospital for Joint Diseases, New York University, Seligman Centre for Advanced Therapeutics, New York, New York. ·Arthritis Rheumatol · Pubmed #26991067.

ABSTRACT: OBJECTIVE: To study bidirectional change and predictors of change in estimated glomerular filtration rate (GFR) and proteinuria in lupus nephritis (LN) using a multistate modeling approach. METHODS: Patients in the Systemic Lupus International Collaborating Clinics inception cohort were classified annually into estimated GFR state 1 (>60 ml/minute), state 2 (30-60 ml/minute), or state 3 (<30 ml/minute) and estimated proteinuria state 1 (<0.25 gm/day), state 2 (0.25-3.0 gm/day), or state 3 (>3.0 gm/day), or end-stage renal disease (ESRD) or death. Using multistate modeling, relative transition rates between states indicated improvement and deterioration. RESULTS: Of 1,826 lupus patients, 700 (38.3%) developed LN. During a mean ± SD follow-up of 5.2 ± 3.5 years, the likelihood of improvement in estimated GFR and estimated proteinuria was greater than the likelihood of deterioration. After 5 years, 62% of patients initially in estimated GFR state 3 and 11% of patients initially in estimated proteinuria state 3 transitioned to ESRD. The probability of remaining in the initial states 1, 2, and 3 was 85%, 11%, and 3%, respectively, for estimated GFR and 62%, 29%, and 4%, respectively, for estimated proteinuria. Male sex predicted improvement in estimated GFR states; older age, race/ethnicity, higher estimated proteinuria state, and higher renal biopsy chronicity scores predicted deterioration. For estimated proteinuria, race/ethnicity, earlier calendar years, damage scores without renal variables, and higher renal biopsy chronicity scores predicted deterioration; male sex, presence of lupus anticoagulant, class V nephritis, and mycophenolic acid use predicted less improvement. CONCLUSION: In LN, the expected improvement or deterioration in renal outcomes can be estimated by multistate modeling and is preceded by identifiable risk factors. New therapeutic interventions for LN should meet or exceed these expectations.

10 Article Metabolic syndrome is not only a risk factor for cardiovascular diseases in systemic lupus erythematosus but is also associated with cumulative organ damage: a cross-sectional analysis of 311 patients. 2016

Demir, S / Artim-Esen, B / Şahinkaya, Y / Pehlivan, Ö / Alpay-Kanıtez, N / Omma, A / Erer, B / Kamalı, S / Gül, A / Aral, O / Öcal, L / İnanç, M. ·Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. · Division of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. · Division of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey drinanc@istanbul.edu.tr. ·Lupus · Pubmed #26354963.

ABSTRACT: BACKGROUND/PURPOSE: Patients with systemic lupus erythematosus (SLE) have increased rates of cardiovascular disease (CVD) that are one of the major causes of mortality. The aim of this study was to determine the frequencies of metabolic syndrome (MetS) and CVD in SLE patients and investigate the link between these and clinical features of SLE. METHODS: A total of 311 SLE patients were consecutively assessed for cumulative organ damage (SDI/SLICC scores), history of CVD and MetS as defined by the National Cholesterol Educational Program Adult Treatment Panel III (NCEP ATP III). Clinical data of SLE patients were collected from the records. RESULTS: The mean age of the patients was 40.2 ± 13.4 years and 89% were female. The frequencies of CVD and MetS were 15.2% and 19%, respectively. In this SLE cohort increased age, cumulative damage, disease duration and CVD were associated with MetS. CVD was associated with disease duration, cumulative damage, pericarditis, hematologic involvement, lymphopenia, thrombocytopenia, neurological involvement and antiphospholipid antibody (aPL) positivity. Hydroxychloroquine (HCQ) use was found as a protective factor for CVD. CONCLUSION: In SLE patients, MetS was associated with CVD and both increased with disease duration. Patients who developed MetS and/or CVD had increased cumulative organ damage. Certain clinical features of SLE and the presence of aPL were also associated with CVD. There was a significant protective effect of HCQ from CVD. The prevention of MetS and long-term use of HCQ may be beneficial in improving the prognosis of SLE.

11 Article The frequency and outcome of lupus nephritis: results from an international inception cohort study. 2016

Hanly, John G / O'Keeffe, Aidan G / Su, Li / Urowitz, Murray B / Romero-Diaz, Juanita / Gordon, Caroline / Bae, Sang-Cheol / Bernatsky, Sasha / Clarke, Ann E / Wallace, Daniel J / Merrill, Joan T / Isenberg, David A / Rahman, Anisur / Ginzler, Ellen M / Fortin, Paul / Gladman, Dafna D / Sanchez-Guerrero, Jorge / Petri, Michelle / Bruce, Ian N / Dooley, Mary Anne / Ramsey-Goldman, Rosalind / Aranow, Cynthia / Alarcón, Graciela S / Fessler, Barri J / Steinsson, Kristjan / Nived, Ola / Sturfelt, Gunnar K / Manzi, Susan / Khamashta, Munther A / van Vollenhoven, Ronald F / Zoma, Asad A / Ramos-Casals, Manuel / Ruiz-Irastorza, Guillermo / Lim, S Sam / Stoll, Thomas / Inanc, Murat / Kalunian, Kenneth C / Kamen, Diane L / Maddison, Peter / Peschken, Christine A / Jacobsen, Soren / Askanase, Anca / Theriault, Chris / Thompson, Kara / Farewell, Vernon. ·Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada, john.hanly@cdha.nshealth.ca. · Department of Statistical Science, University College London, London. · MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Cambridge, UK. · Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada. · Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico. · Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. · Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea. · Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre. · Division of Rheumatology, University of Calgary, Alberta, Canada. · Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA. · Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA. · Centre for Rheumatology, Department of Medicine, University College London, UK. · Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA. · Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Canada. · Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, 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. · Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC. · Northwestern University and Feinberg School of Medicine, Chicago, IL. · Feinstein Institute for Medical Research, Manhasset, NY. · Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. · Center for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland. · Department of Rheumatology, University Hospital Lund, Lund, Sweden. · Division of Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. · Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK. · Unit for Clinical Therapy Research, Karolinska Institute, Stockholm, Sweden. · Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK. · 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. · Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia, USA. · Kantonsspital Geissbergstr, Schaffhausen, Switzerland. · Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. · UCSD School of Medicine, La Jolla, CA. · Medical University of South Carolina, Charleston, SC, USA. · Ysbyty Gwynedd Bangor, Gwynedd, North Wales, UK. · University of Manitoba, Winnipeg, Manitoba, Canada. · Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. · Hospital for Joint Diseases, NYU, Seligman Centre for Advanced Therapeutics, New York, NY, USA and. · Department of Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. ·Rheumatology (Oxford) · Pubmed #26342222.

ABSTRACT: OBJECTIVE: To determine nephritis outcomes in a prospective multi-ethnic/racial SLE inception cohort. METHODS: Patients in the Systemic Lupus International Collaborating Clinics inception cohort (≤15 months of SLE diagnosis) were assessed annually for estimated glomerular filtration rate (eGFR), proteinuria and end-stage renal disease (ESRD). Health-related quality of life was measured by the Short Form (36 questions) health survey questionnaire (SF-36) subscales, mental and physical component summary scores. RESULTS: There were 1827 patients, 89% females, mean (s.d.) age 35.1 (13.3) years. The mean (s.d.) SLE duration at enrolment was 0.5 (0.3) years and follow-up 4.6 (3.4) years. LN occurred in 700 (38.3%) patients: 566/700 (80.9%) at enrolment and 134/700 (19.1%) during follow-up. Patients with nephritis were younger, more frequently men and of African, Asian and Hispanic race/ethnicity. The estimated overall 10-year incidence of ESRD was 4.3% (95% CI: 2.8%, 5.8%), and with nephritis was 10.1% (95% CI: 6.6%, 13.6%). Patients with nephritis had a higher risk of death (HR = 2.98, 95% CI: 1.48, 5.99; P = 0.002) and those with eGFR <30 ml/min at diagnosis had lower SF-36 physical component summary scores (P < 0.01) and lower Physical function, Physical role and Bodily pain scores. Over time, patients with abnormal eGFR and proteinuria had lower SF-36 mental component summary (P ≤ 0.02) scores compared to patients with normal values. CONCLUSION: LN occurred in 38.3% of SLE patients, frequently as the initial presentation, in a large multi-ethnic inception cohort. Despite current standard of care, nephritis was associated with ESRD and death, and renal insufficiency was linked to lower health-related quality of life. Further advances are required for the optimal treatment of LN.

12 Article Mood Disorders in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. 2015

Hanly, John G / Su, Li / Urowitz, Murray B / Romero-Diaz, Juanita / Gordon, Caroline / Bae, Sang-Cheol / Bernatsky, Sasha / Clarke, Ann E / Wallace, Daniel J / Merrill, Joan T / Isenberg, David A / Rahman, Anisur / Ginzler, Ellen M / Petri, Michelle / Bruce, Ian N / Dooley, M A / Fortin, Paul / Gladman, Dafna D / Sanchez-Guerrero, Jorge / Steinsson, Kristjan / Ramsey-Goldman, Rosalind / Khamashta, Munther A / Aranow, Cynthia / Alarcón, Graciela S / Fessler, Barri J / Manzi, Susan / Nived, Ola / Sturfelt, Gunnar K / 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 / Thompson, Kara / Farewell, Vernon. ·Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. · Institute of Public Health and University of Cambridge, University Forvie Site, Cambridge, UK. · Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada. · Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico. · University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK. · Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea. · McGill University Health Centre, Montreal, Quebec, Canada. · University of Calgary, Calgary, Alberta, Canada. · Cedars-Sinai Medical Center and University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California. · Oklahoma Medical Research Foundation, Oklahoma City. · University College London, London, UK. · State University of New York Downstate Medical Center, Brooklyn. · Johns Hopkins University, Baltimore, Maryland. · Manchester Academic Health Sciences Centre, University of Manchester, and Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK. · University of North Carolina, Chapel Hill. · Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, Quebec, Canada. · Landspitali University Hospital, Reykjavik, Iceland. · Northwestern University and Feinberg School of Medicine, Chicago, Illinois. · The Rayne Institute, St. Thomas' Hospital, and 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. · University Hospital Lund, Lund, Sweden. · Lanarkshire Centre for Rheumatology and Hairmyres Hospital, East Kilbride, UK. · Karolinska Institute, Stockholm, Sweden. · Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain. · Hospital de Cruces and University of the Basque Country, Barakaldo, Spain. · Emory University, Atlanta, Georgia. · University of California at San Diego, La, Jolla. · Istanbul University, Istanbul, Turkey. · Medical University of South Carolina, Charleston. · University of Manitoba, Winnipeg, Manitoba, Canada. · Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. · New York University, New York, New York. ·Arthritis Rheumatol · Pubmed #25778456.

ABSTRACT: OBJECTIVE: To examine the frequency, characteristics, and outcome of mood disorders, as well as clinical and autoantibody associations, in a multiethnic/racial, prospective inception cohort of patients with systemic lupus erythematosus (SLE). METHODS: Patients were assessed annually for mood disorders (4 types, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and 18 other neuropsychiatric events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 subscales, mental and physical component summary scores were collected. Time to event, linear and ordinal regressions, and multi-state models were used as appropriate. RESULTS: Among the 1,827 patients with SLE, 88.9% were female, and 48.9% were Caucasian. The mean ± SD age of the patients was 35.1 ± 13.3 years, disease duration was 5.6 ± 4.8 months, and the length of followup was 4.7 ± 3.5 years. During the course of the study, 863 (47.2%) of the 1,827 patients had 1,627 neuropsychiatric events. Mood disorders occurred in 232 (12.7%) of 1,827 patients, and 98 (38.3%) of 256 mood disorder events were attributed to SLE. The estimated cumulative incidence of any mood disorder after 10 years was 17.7% (95% confidence interval 15.1, 20.2%). A greater risk of mood disorder was associated with concurrent neuropsychiatric events (P ≤ 0.01), and a lower risk was associated with Asian race/ethnicity (P = 0.01) and treatment with immunosuppressive drugs (P = 0.003). Mood disorders were associated with lower mental health and mental component summary scores but not with the SLEDAI-2K, SDI, or lupus autoantibodies. Among the 232 patients with depression, 168 (72.4%) were treated with antidepressants. One hundred twenty-six (49.2%) of 256 mood disorders resolved in 117 (50.4%) of 232 patients. CONCLUSION: Mood disorders, the second most frequent neuropsychiatric event in patients with SLE, have a negative impact on health-related quality of life and improve over time. The lack of association with global SLE disease activity, cumulative organ damage, and lupus autoantibodies emphasizes the multifactorial etiology of mood disorders and a role for non-lupus-specific therapies.

13 Article Treatment Algorithms in Systemic Lupus Erythematosus. 2015

Muangchan, Chayawee / van Vollenhoven, Ronald F / Bernatsky, Sasha R / Smith, C Douglas / Hudson, Marie / Inanç, Murat / Rothfield, Naomi F / Nash, Peter T / Furie, Richard A / Senécal, Jean-Luc / Chandran, Vinod / Burgos-Vargas, Ruben / Ramsey-Goldman, Rosalind / Pope, Janet E. ·Siriraj Hospital, Mahidol University, Bangkok, Thailand, and University of Western Ontario, London, Ontario, Canada. · Karolinska Institute, Stockholm, Sweden. · Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada. · University of Ottawa, Ottawa, Ontario, Canada. · Jewish General Hospital and McGill University, Montreal, Quebec, Canada. · Istanbul University, Istanbul, Turkey. · University of Connecticut Health Center, Farmington. · University of Queensland, Brisbane, Queensland, Australia. · North Shore LIJ Health System, Great Neck, New York. · Centre Hospitalier and School of Medicine of the University of Montreal, Montreal, Quebec, Canada. · University of Toronto and University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada. · Hospital General de México and Universidad Nacional Autónoma de México, Mexico City, Mexico. · Northwestern University Feinberg School of Medicine, Chicago, Illinois. · University of Western Ontario, London, Ontario, Canada. ·Arthritis Care Res (Hoboken) · Pubmed #25777803.

ABSTRACT: OBJECTIVE: To establish agreement on systemic lupus erythematosus (SLE) treatment. METHODS: SLE experts (n = 69) were e-mailed scenarios and indicated preferred treatments. Algorithms were constructed and agreement determined (≥50% respondents indicating ≥70% agreement). RESULTS: Initially, 54% (n = 37) responded suggesting treatment for scenarios; 13 experts rated agreement with scenarios. Fourteen of 16 scenarios had agreement as follows: discoid lupus: first-line therapy was topical agents and hydroxychloroquine and/or glucocorticoids then azathioprine and subsequently mycophenolate (mofetil); uncomplicated cutaneous vasculitis: initial treatment was glucocorticoids ± hydroxychloroquine ± methotrexate, followed by azathioprine or mycophenolate and then cyclophosphamide; arthritis: initial therapy was hydroxychloroquine and/or glucocorticoids, then methotrexate and subsequently rituximab; pericarditis: first-line therapy was nonsteroidal antiinflammatory drugs, then glucocorticoids with/without hydroxychloroquine, then azathioprine, mycophenolate, or methotrexate and finally belimumab or rituximab, and/or a pericardial window; interstitial lung disease/alveolitis: induction was glucocorticoids and mycophenolate or cyclophosphamide, then rituximab or intravenous gamma globulin (IVIG), and maintenance followed with azathioprine or mycophenolate; pulmonary hypertension: glucocorticoids and mycophenolate or cyclophosphamide and an endothelin receptor antagonist were initial therapies, subsequent treatments were phosphodiesterase-5 inhibitors and then prostanoids and rituximab; antiphospholipid antibody syndrome: standard anticoagulation with/without hydroxychloroquine, then a thrombin inhibitor for venous thrombosis, versus adding aspirin or platelet inhibition drugs for arterial events; mononeuritis multiplex and central nervous system vasculitis: first-line therapy was glucocorticoids and cyclophosphamide followed by maintenance with azathioprine or mycophenolate, and then rituximab, IVIG, or plasmapheresis; and serious lupus nephritis: first-line therapy was glucocorticoids and mycophenolate, then cyclophosphamide then rituximab. CONCLUSION: We established variable agreement on treatment approaches. For some treatment decisions there was good agreement between experts even if no randomized controlled trial data were available.

14 Article Anti-C1q antibodies in systemic lupus erythematosus. 2015

Orbai, A-M / Truedsson, L / Sturfelt, G / Nived, O / Fang, H / Alarcón, G S / Gordon, C / Merrill, Jt / Fortin, P R / Bruce, I N / Isenberg, D A / Wallace, D J / Ramsey-Goldman, R / Bae, S-C / Hanly, J G / Sanchez-Guerrero, J / Clarke, A E / Aranow, C B / Manzi, S / Urowitz, M B / Gladman, D D / Kalunian, K C / Costner, M I / Werth, V P / Zoma, A / Bernatsky, S / Ruiz-Irastorza, G / Khamashta, M A / Jacobsen, S / Buyon, J P / Maddison, P / Dooley, M A / Van Vollenhoven, R F / Ginzler, E / Stoll, T / Peschken, C / Jorizzo, J L / Callen, J P / Lim, S S / Fessler, B J / Inanc, M / Kamen, D L / Rahman, A / Steinsson, K / Franks, A G / Sigler, L / Hameed, S / Pham, N / Brey, R / Weisman, M H / McGwin, G / Magder, L S / Petri, M. ·Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Laboratory Medicine, Section of Microbiology, Immunology and Glycobiology, Lund University, Lund, Sweden. · Department of Rheumatology, Skåne University Hospital, Lund, Sweden. · Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA. · Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences University of Birmingham, Birmingham, UK. · Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA. · Division of Rheumatology, Department of Medicine, Centre Hospitalier Universitaire (CHU) de Québec Axe Maladies Infectieuses et Immunitaires, CRCHU de Québec, Université Laval, Quebec City, Quebec, Canada. · Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK. · Centre for Rheumatology, Research Division of Medicine, London, UK. · Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. · Northwestern University, Feinberg School of Medicine, Chicago, IL, USA. · Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea. · Division of Rheumatology, Departments of Medicine and Pathology Capital Health and Dalhousie University, Halifax, Nova Scotia, Canada. · Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada. · Divisions of Clinical Epidemiology and Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada. · Feinstein Institute for Medical Research, Manhasset, NY, USA. · Department of Medicine, Division of Rheumatology, Allegheny Singer Research Institute, Allegheny General Hospital, Pittsburgh, PA, USA. · Toronto Western Hospital Toronto, Ontario, Canada. · Division of Rheumatology, Allergy and Immunology, UCSD School of Medicine, La Jolla, CA, USA. · North Dallas Dermatology Associates, Dallas, TX, USA. · Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia, PA, USA. · Lanarkshire Centre for Rheumatology and Hairmyres Hospital, East Kilbride, UK. · Autoimmune Diseases Research Unit, Hospital Universitario Cruces Universidad del Pais Vasco, Barakaldo, Spain. · Rayne Institute and St Thomas' Hospital London, UK. · Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. · New York University, New York, NY, USA. · Ysbyty Gwynedd, Bangor, UK. · University of North Carolina, Chapel Hill, NC, USA. · Karolinska University Hospital, Stockholm, Sweden. · State University of New York, Downstate Medical Center, Brooklyn, NY, USA. · Kantonsspital Schaffhausen, Schaffhausen, Switzerland. · University of Manitoba Winnipeg, Manitoba, Canada. · Wake Forest University, Winston-Salem, NC, USA. · University of Louisville, Louisville, KY, USA. · Emory University, Atlanta, GA, USA. · Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. · Medical University of South Carolina, Charleston, SC, USA. · NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK. · Landspitali University Hospital, Reykjavik, Iceland. · University of Texas Health Science Center, San Antonio, TX, USA. · Cedars-Sinai Medical Center, Los Angeles, CA, USA. · Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA. · Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA MPetri@jhmi.edu. ·Lupus · Pubmed #25124676.

ABSTRACT: OBJECTIVE: Anti-C1q has been associated with systemic lupus erythematosus (SLE) and lupus nephritis in previous studies. We studied anti-C1q specificity for SLE (vs rheumatic disease controls) and the association with SLE manifestations in an international multicenter study. METHODS: Information and blood samples were obtained in a cross-sectional study from patients with SLE (n = 308) and other rheumatologic diseases (n = 389) from 25 clinical sites (84% female, 68% Caucasian, 17% African descent, 8% Asian, 7% other). IgG anti-C1q against the collagen-like region was measured by ELISA. RESULTS: Prevalence of anti-C1q was 28% (86/308) in patients with SLE and 13% (49/389) in controls (OR = 2.7, 95% CI: 1.8-4, p < 0.001). Anti-C1q was associated with proteinuria (OR = 3.0, 95% CI: 1.7-5.1, p < 0.001), red cell casts (OR = 2.6, 95% CI: 1.2-5.4, p = 0.015), anti-dsDNA (OR = 3.4, 95% CI: 1.9-6.1, p < 0.001) and anti-Smith (OR = 2.8, 95% CI: 1.5-5.0, p = 0.01). Anti-C1q was independently associated with renal involvement after adjustment for demographics, ANA, anti-dsDNA and low complement (OR = 2.3, 95% CI: 1.3-4.2, p < 0.01). Simultaneously positive anti-C1q, anti-dsDNA and low complement was strongly associated with renal involvement (OR = 14.9, 95% CI: 5.8-38.4, p < 0.01). CONCLUSIONS: Anti-C1q was more common in patients with SLE and those of Asian race/ethnicity. We confirmed a significant association of anti-C1q with renal involvement, independent of demographics and other serologies. Anti-C1q in combination with anti-dsDNA and low complement was the strongest serological association with renal involvement. These data support the usefulness of anti-C1q in SLE, especially in lupus nephritis.

15 Article Factors associated with damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort. 2015

Bruce, Ian N / O'Keeffe, Aidan G / Farewell, Vern / Hanly, John G / Manzi, Susan / Su, Li / Gladman, Dafna D / Bae, Sang-Cheol / Sanchez-Guerrero, Jorge / Romero-Diaz, Juanita / Gordon, Caroline / Wallace, Daniel J / Clarke, Ann E / Bernatsky, Sasha / Ginzler, Ellen M / Isenberg, David A / Rahman, Anisur / Merrill, Joan T / Alarcón, Graciela S / Fessler, Barri J / Fortin, Paul R / Petri, Michelle / Steinsson, Kristjan / Dooley, Mary Anne / Khamashta, Munther A / Ramsey-Goldman, Rosalind / Zoma, Asad A / Sturfelt, Gunnar K / Nived, Ola / Aranow, Cynthia / Mackay, Meggan / Ramos-Casals, Manuel / van Vollenhoven, Ronald F / Kalunian, Kenneth C / Ruiz-Irastorza, Guillermo / Lim, Sam / Kamen, Diane L / Peschken, Christine A / Inanc, Murat / Urowitz, Murray B. ·Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK The Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. · Department of Statistical Science, University College London, London, UK. · MRC Biostatistics Unit, Cambridge, UK. · Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. · Department of Medicine, West Penn Allegheny Health System, Pittsburgh, Pennsylvania, USA. · Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada. · Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea. · Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico. · Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. · Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, California, USA. · Division of Rheumatology, University of Calgary, Alberta, Canada. · Divisions of Clinical Immunology/Allergy and Clinical Epidemiology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada. · Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA. · Centre for Rheumatology Research, University College London, London, UK. · Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA. · Department of Medicine, Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, Alabama, USA. · Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Quebec, Canada. · Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Center for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland. · Division of Rheumatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA. · Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK. · Northwestern University and Feinberg School of Medicine, Chicago, Illinois, USA. · Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK. · Department of Rheumatology, University Hospital Lund, Lund, Sweden. · Feinstein Institute for Medical Research, Manhasset, New York, USA. · Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain. · Unit for Clinical Therapy Research Inflammatory Diseases (ClinTRID), Karolinska Institute, Stockholm, Sweden. · UCSD School of Medicine, La Jolla, California, USA. · Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain. · Emory University, Atlanta, Georgia, USA. · Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA. · University of Manitoba, Winnipeg, Manitoba, Canada. · Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. ·Ann Rheum Dis · Pubmed #24834926.

ABSTRACT: BACKGROUND AND AIMS: We studied damage accrual and factors determining development and progression of damage in an international cohort of systemic lupus erythematosus (SLE) patients. METHODS: The Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort recruited patients within 15 months of developing four or more 1997 American College of Rheumatology (ACR) criteria for SLE; the SLICC/ACR damage index (SDI) was measured annually. We assessed relative rates of transition using maximum likelihood estimation in a multistate model. The Kaplan-Meier method estimated the probabilities for time to first increase in SDI score and Cox regression analysis was used to assess mortality. RESULTS: We recruited 1722 patients; mean (SD) age 35.0 (13.4) years at cohort entry. Patients with damage at enrolment were more likely to have further worsening of SDI (SDI 0 vs ≥1; p<0.001). Age, USA African race/ethnicity, SLEDAI-2K score, steroid use and hypertension were associated with transition from no damage to damage, and increase(s) in pre-existing damage. Male gender (relative transition rates (95% CI) 1.48 (1.06 to 2.08)) and USA Caucasian race/ethnicity (1.63 (1.08 to 2.47)) were associated with SDI 0 to ≥1 transitions; Asian race/ethnicity patients had lower rates of new damage (0.60 (0.39 to 0.93)). Antimalarial use was associated with lower rates of increases in pre-existing damage (0.63 (0.44 to 0.89)). Damage was associated with future mortality (HR (95% CI) 1.46 (1.18 to 1.81) per SDI point). CONCLUSIONS: Damage in SLE predicts future damage accrual and mortality. We identified several potentially modifiable risk factors for damage accrual; an integrated strategy to address these may improve long-term outcomes.

16 Article Impact of early disease factors on metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort. 2015

Parker, Ben / Urowitz, Murray B / Gladman, Dafna D / Lunt, Mark / Donn, Rachelle / Bae, Sang-Cheol / Sanchez-Guerrero, Jorge / Romero-Diaz, Juanita / Gordon, Caroline / Wallace, Daniel J / Clarke, Ann E / Bernatsky, Sasha / Ginzler, Ellen M / Isenberg, David A / Rahman, Anisur / Merrill, Joan T / Alarcón, Graciela S / Fessler, Barri J / Fortin, Paul R / Hanly, John G / Petri, Michelle / Steinsson, Kristjan / Dooley, Mary Anne / Manzi, Susan / Khamashta, Munther A / Ramsey-Goldman, Rosalind / Zoma, Asad A / Sturfelt, Gunnar K / Nived, Ola / Aranow, Cynthia / Mackay, Meggan / Ramos-Casals, Manuel / van Vollenhoven, Ronald F / Kalunian, Kenneth C / Ruiz-Irastorza, Guillermo / Lim, S Sam / Kamen, Diane L / Peschken, Christine A / Inanc, Murat / Bruce, Ian N. ·Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Toronto, Ontario, Canada. · Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada. · Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK. · Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea. · Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico. · Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. · Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, California, USA. · Divisions of Clinical Immunology/Allergy and Clinical Epidemiology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada. · Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA. · Centre for Rheumatology Research, University College, London, UK. · Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA. · Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. · Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Quebec, Canada. · Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. · Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Center for Rheumatology Research, Landspitali University hospital, Reykjavik, Iceland. · Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA. · Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania, USA. · Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK. · Northwestern University and Feinberg School of Medicine, Chicago, Illinois, USA. · Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK. · Department of Rheumatology, University Hospital Lund, Lund, Sweden. · Feinstein Institute for Medical Research, Manhasset, New York, USA. · Department of Autoimmune Diseases, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Hospital Clínic, Barcelona, Spain. · Unit for Clinical Therapy Research (ClinTRID), The Karolinska Institute, Stockholm, Sweden. · UCSD School of Medicine, La Jolla, California, USA. · Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain. · Emory University, Atlanta, Georgia, USA. · Medical University of South Carolina, Charleston, South Carolina, USA. · University of Manitoba, Winnipeg, Manitoba, Canada. · Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. ·Ann Rheum Dis · Pubmed #24692585.

ABSTRACT: BACKGROUND: The metabolic syndrome (MetS) may contribute to the increased cardiovascular risk in systemic lupus erythematosus (SLE). We examined the association between MetS and disease activity, disease phenotype and corticosteroid exposure over time in patients with SLE. METHODS: Recently diagnosed (<15 months) patients with SLE from 30 centres across 11 countries were enrolled into the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort from 2000 onwards. Baseline and annual assessments recorded clinical, laboratory and therapeutic data. A longitudinal analysis of factors associated with MetS in the first 2 years of follow-up was performed using random effects logistic regression. RESULTS: We studied 1150 patients with a mean (SD) age of 34.9 (13.6) years and disease duration at enrolment of 24.2 (18.0) weeks. In those with complete data, MetS prevalence was 38.2% at enrolment, 34.8% at year 1 and 35.4% at year 2. In a multivariable random effects model that included data from all visits, prior MetS status, baseline renal disease, SLICC Damage Index >1, higher disease activity, increasing age and Hispanic or Black African race/ethnicity were independently associated with MetS over the first 2 years of follow-up in the cohort. CONCLUSIONS: MetS is a persistent phenotype in a significant proportion of patients with SLE. Renal lupus, active inflammatory disease and damage are SLE-related factors that drive MetS development while antimalarial agents appear to be protective from early in the disease course.

17 Article Cluster analysis of autoantibodies in 852 patients with systemic lupus erythematosus from a single center. 2014

Artim-Esen, Bahar / Çene, Erhan / Şahinkaya, Yasemin / Ertan, Semra / Pehlivan, Özlem / Kamali, Sevil / Gül, Ahmet / Öcal, Lale / Aral, Orhan / Inanç, Murat. ·From the Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University; Department of Statistics, Faculty of Arts and Sciences, Yildiz Technical University, Istanbul, Turkey.B. Artim-Esen, MD, Fellow, Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University; E. Çene, Fellow, Department of Statistics, Faculty of Arts and Sciences, Yildiz Technical University; Y. Şahinkaya, MD, Fellow; S. Ertan, MD, Fellow; Ö. Pehlivan, MD, Fellow; S. Kamali, MD, Professor; A. Gül, MD, Professor; L. Öcal, MD, Professor; O. Aral, MD, Professor; M. Inanç, MD, Professor, Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University. ·J Rheumatol · Pubmed #24833757.

ABSTRACT: OBJECTIVE: Associations between autoantibodies and clinical features have been described in systemic lupus erythematosus (SLE). Herein, we aimed to define autoantibody clusters and their clinical correlations in a large cohort of patients with SLE. METHODS: We analyzed 852 patients with SLE who attended our clinic. Seven autoantibodies were selected for cluster analysis: anti-DNA, anti-Sm, anti-RNP, anticardiolipin (aCL) immunoglobulin (Ig)G or IgM, lupus anticoagulant (LAC), anti-Ro, and anti-La. Two-step clustering and Kaplan-Meier survival analyses were used. RESULTS: Five clusters were identified. A cluster consisted of patients with only anti-dsDNA antibodies, a cluster of anti-Sm and anti-RNP, a cluster of aCL IgG/M and LAC, and a cluster of anti-Ro and anti-La antibodies. Analysis revealed 1 more cluster that consisted of patients who did not belong to any of the clusters formed by antibodies chosen for cluster analysis. Sm/RNP cluster had significantly higher incidence of pulmonary hypertension and Raynaud phenomenon. DsDNA cluster had the highest incidence of renal involvement. In the aCL/LAC cluster, there were significantly more patients with neuropsychiatric involvement, antiphospholipid syndrome, autoimmune hemolytic anemia, and thrombocytopenia. According to the Systemic Lupus International Collaborating Clinics damage index, the highest frequency of damage was in the aCL/LAC cluster. Comparison of 10 and 20 years survival showed reduced survival in the aCL/LAC cluster. CONCLUSION: This study supports the existence of autoantibody clusters with distinct clinical features in SLE and shows that forming clinical subsets according to autoantibody clusters may be useful in predicting the outcome of the disease. Autoantibody clusters in SLE may exhibit differences according to the clinical setting or population.

18 Article Comparing female-based contraceptive methods in patients with systemic lupus erythematosus, rheumatoid arthritis and a healthy population. 2014

Dalkilic, Ediz / Tufan, Ayse Nur / Oksuz, Mustafa Ferhat / Sahbazlar, Mustafa / Coskun, Belkis Nihan / Seniz, Nihan / Pehlivan, Yavuz / Inanc, Murat. ·Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Uludag University, Istanbul, Turkey. ·Int J Rheum Dis · Pubmed #24673794.

ABSTRACT: AIM: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that is 10 times more prevalent in women, particularly those of reproductive age. The varying effects of pregnancy on SLE and the differences between available SLE treatments make pregnancy timing and contraceptive methods significant. We aimed to determine the contraceptive methods used by SLE patients in the north-west part of Turkey, and compared them with those used by rheumatoid arthritis (RA) patients and healthy controls. METHOD: The study was comprised of 113 SLE patients, and 84 RA patients at the Rheumatology Outpatient Clinic of Uludag University Medical Faculty. RESULTS: Twenty-three (20.3%) out of 113 SLE patients, 18 (21.4%) out of 84 RA patients and 17 (18.6%) out of 92 healthy controls did not use any contraceptive methods. Use of the withdrawal and condom methods was more common among SLE patients, accounting for 61% (withdrawal 32.7%, condom 28.3%). Moreover, 52% of SLE and 50% of RA patients were neither given information about contraceptive methods nor offered a suggested method, compared to 34% in the health control group. CONCLUSIONS: The prevalence of oral contraceptive use is low in Turkey; notwithstanding the withdrawal and condom methods, which are frequently used despite their high failure risk. Although pregnancy timing is of great importance for SLE patients, necessary information and recommendations concerning contraceptive methods have been ignored and the use of effective methods is not a priority.

19 Article MEFV gene variations in patients with systemic lupus erythematosus. 2014

Erer, Burak / Cosan, Fulya / Oku, Basar / Ustek, Duran / Inanc, Murat / Aral, Orhan / Gul, Ahmet. ·Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine , Istanbul 34390 , Turkey. ·Mod Rheumatol · Pubmed #24261764.

ABSTRACT: OBJECTIVE: The aim of this study was to investigate the frequency of familial Mediterranean fever (FMF)-associated MEFV gene variations in patients with systemic lupus erythematosus (SLE). METHODS: The study group comprised 190 SLE patients and 101 healthy controls of Turkish origin with no clinical features of FMF. All individuals were genotyped for the four most common MEFV gene variations (M694V, M680I, V726A and E148Q) by PCR-restriction fragment length polymorphism analysis. RESULTS: The frequency of carrying any of the four MEFV gene variations under study was 15 % in patients with SLE and 10 % in the healthy controls (p = 0.23). After the exclusion of the less penetrant E148Q variation, re-analysis for the three penetrant mutations revealed a significant association between exon 10 variations and pericarditis [p = 0.038, odds ratio (OR) 3.5, 95 % confidence interval (CI) 1.0-12.1], and pleural effusion (p = 0.043, OR 5.2, 95 % CI 0.8-30.9). No significant association was detected between the MEFV gene variations and a higher acute phase response. CONCLUSIONS: The MEFV gene variations analyzed in our study do not seem to increase the overall susceptibility to SLE and do not have any strong association with its clinical manifestations. The possibility of a modest effect of penetrant exon 10 MEFV variants on the development of serosal effusions needs to be explored in a larger series of patients.

20 Article Headache in systemic lupus erythematosus: results from a prospective, international inception cohort study. 2013

Hanly, John G / Urowitz, Murray B / O'Keeffe, Aidan G / Gordon, Caroline / Bae, Sang-Cheol / Sanchez-Guerrero, Jorge / Romero-Diaz, Juanita / Clarke, Ann E / Bernatsky, Sasha / Wallace, Daniel J / Ginzler, Ellen M / Isenberg, David A / Rahman, Anisur / Merrill, Joan T / Petri, Michelle / Fortin, Paul R / Gladman, Dafna D / Fessler, Barri J / Alarcón, Graciela S / Bruce, Ian N / Dooley, Mary Anne / Steinsson, Kristjan / Khamashta, Munther A / Ramsey-Goldman, Rosalind / Manzi, Susan / Sturfelt, Gunnar K / Nived, Ola / Zoma, Asad A / van Vollenhoven, Ronald F / Ramos-Casals, Manuel / Aranow, Cynthia / Mackay, Meggan / Ruiz-Irastorza, Guillermo / Kalunian, Kenneth C / Lim, S Sam / Inanc, Murat / Kamen, Diane L / Peschken, Christine A / Jacobsen, Soren / Theriault, Chris / Thompson, Kara / Farewell, Vernon. ·Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. ·Arthritis Rheum · Pubmed #24166793.

ABSTRACT: OBJECTIVE: To examine the frequency and characteristics of headaches and their association with global disease activity and health-related quality of life (HRQOL) in patients with systemic lupus erythematosus (SLE). METHODS: A disease inception cohort was assessed annually for headache (5 types) and 18 other neuropsychiatric (NP) events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 (SF-36) mental and physical component summary scores were collected. Time to first headache and associations with SF-36 scores were analyzed using Cox proportional hazards and linear regression models with generalized estimating equations. RESULTS: Among the 1,732 SLE patients enrolled, 89.3% were female and 48.3% were white. The mean ± SD age was 34.6 ± 13.4 years, duration of disease was 5.6 ± 5.2 months, and length of followup was 3.8 ± 3.1 years. At enrollment, 17.8% of patients had headache (migraine [60.7%], tension [38.6%], intractable nonspecific [7.1%], cluster [2.6%], and intracranial hypertension [1.0%]). The prevalence of headache increased to 58% after 10 years. Only 1.5% of patients had lupus headache, as identified in the SLEDAI-2K. In addition, headache was associated with other NP events attributed to either SLE or non-SLE causes. There was no association of headache with SLEDAI-2K scores (without the lupus headache variable), SDI scores, use of corticosteroids, use of antimalarials, use of immunosuppressive medications, or specific autoantibodies. SF-36 mental component scores were lower in patients with headache compared with those without headache (mean ± SD 42.5 ± 12.2 versus 47.8 ± 11.3; P < 0.001), and similar differences in physical component scores were seen (38.0 ± 11.0 in those with headache versus 42.6 ± 11.4 in those without headache; P < 0.001). In 56.1% of patients, the headaches resolved over followup. CONCLUSION: Headache is frequent in SLE, but overall, it is not associated with global disease activity or specific autoantibodies. Although headaches are associated with a lower HRQOL, the majority of headaches resolve over time, independent of lupus-specific therapies.

21 Article Clinical associations of the metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort. 2013

Parker, Ben / Urowitz, Murray B / Gladman, Dafna D / Lunt, Mark / Bae, Sang-Cheol / Sanchez-Guerrero, Jorge / Romero-Diaz, Juanita / Gordon, Caroline / Wallace, Daniel J / Clarke, Ann E / Bernatsky, Sasha / Ginzler, Ellen M / Isenberg, David A / Rahman, Anisur / Merrill, Joan T / Alarcón, Graciela S / Fessler, Barri J / Fortin, Paul R / Hanly, John G / Petri, Michelle / Steinsson, Kristjan / Dooley, Mary-Anne / Manzi, Susan / Khamashta, Munther A / Ramsey-Goldman, Rosalind / Zoma, Asad A / Sturfelt, Gunnar K / Nived, Ola / Aranow, Cynthia / Mackay, Meggan / Ramos-Casals, Manuel / van Vollenhoven, Raymond F / Kalunian, Kenneth C / Ruiz-Irastorza, Guillermo / Lim, Sam / Kamen, Diane L / Peschken, Christine A / Inanc, Murat / Bruce, Ian N. ·Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK. ·Ann Rheum Dis · Pubmed #22945501.

ABSTRACT: BACKGROUND: The metabolic syndrome (MetS) may contribute to increased cardiovascular risk in systemic lupus erythematosus (SLE). We aimed to examine the association of demographic factors, lupus phenotype and therapy exposure with the presence of MetS. METHODS: The Systemic Lupus International Collaborating Clinics Registry for Atherosclerosis inception cohort enrolled recently diagnosed (<15 months) SLE patients from 30 centres across 11 countries from 2000. Clinical, laboratory and therapeutic data were collected according to a standardised protocol. MetS was defined according to the 2009 consensus statement from the International Diabetes Federation. Univariate and backward stepwise multivariate logistic regression were used to assess the relationship of individual variables with MetS. RESULTS: We studied 1686 patients, of whom 1494 (86.6%) had sufficient data to determine their MetS status. The mean (SD) age at enrolment and disease duration was 35.2 years (13.4) and 24.1 weeks (18.0), respectively. MetS was present at the enrolment visit in 239 (16%). In backward stepwise multivariable regression analysis, higher daily average prednisolone dose (mg) (OR 1.02, 95% CI 1.00 to 1.03), older age (years) (OR 1.04, 95% CI 1.03 to 1.06), Korean (OR 6.33, 95% CI 3.68 to 10.86) and Hispanic (OR 6.2, 95% CI 3.78 to 10.12) ethnicity, current renal disease (OR 1.79, 95% CI 1.14 to 2.80) and immunosuppressant use (OR 1.81, 95% CI 1.18 to 2.78) were associated with MetS. CONCLUSIONS: Renal lupus, higher corticosteroid doses, Korean and Hispanic ethnicity are associated with MetS in SLE patients. Balancing disease control and minimising corticosteroid exposure should therefore be at the forefront of personalised treatment decisions in SLE patients.

22 Article Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. 2012

Petri, Michelle / Orbai, Ana-Maria / Alarcón, Graciela S / Gordon, Caroline / Merrill, Joan T / Fortin, Paul R / Bruce, Ian N / Isenberg, David / Wallace, Daniel J / Nived, Ola / Sturfelt, Gunnar / Ramsey-Goldman, Rosalind / Bae, Sang-Cheol / Hanly, John G / Sánchez-Guerrero, Jorge / Clarke, Ann / Aranow, Cynthia / Manzi, Susan / Urowitz, Murray / Gladman, Dafna / Kalunian, Kenneth / Costner, Melissa / Werth, Victoria P / Zoma, Asad / Bernatsky, Sasha / Ruiz-Irastorza, Guillermo / Khamashta, Munther A / Jacobsen, Soren / Buyon, Jill P / Maddison, Peter / Dooley, Mary Anne / van Vollenhoven, Ronald F / Ginzler, Ellen / Stoll, Thomas / Peschken, Christine / Jorizzo, Joseph L / Callen, Jeffrey P / Lim, S Sam / Fessler, Barri J / Inanc, Murat / Kamen, Diane L / Rahman, Anisur / Steinsson, Kristjan / Franks, Andrew G / Sigler, Lisa / Hameed, Suhail / Fang, Hong / Pham, Ngoc / Brey, Robin / Weisman, Michael H / McGwin, Gerald / Magder, Laurence S. ·Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7500, Baltimore, MD 21205, USA. mpetri@jhmi.edu ·Arthritis Rheum · Pubmed #22553077.

ABSTRACT: OBJECTIVE: The Systemic Lupus International Collaborating Clinics (SLICC) group revised and validated the American College of Rheumatology (ACR) systemic lupus erythematosus (SLE) classification criteria in order to improve clinical relevance, meet stringent methodology requirements, and incorporate new knowledge regarding the immunology of SLE. METHODS: The classification criteria were derived from a set of 702 expert-rated patient scenarios. Recursive partitioning was used to derive an initial rule that was simplified and refined based on SLICC physician consensus. The SLICC group validated the classification criteria in a new validation sample of 690 new expert-rated patient scenarios. RESULTS: Seventeen criteria were identified. In the derivation set, the SLICC classification criteria resulted in fewer misclassifications compared with the current ACR classification criteria (49 versus 70; P = 0.0082) and had greater sensitivity (94% versus 86%; P < 0.0001) and equal specificity (92% versus 93%; P = 0.39). In the validation set, the SLICC classification criteria resulted in fewer misclassifications compared with the current ACR classification criteria (62 versus 74; P = 0.24) and had greater sensitivity (97% versus 83%; P < 0.0001) but lower specificity (84% versus 96%; P < 0.0001). CONCLUSION: The new SLICC classification criteria performed well in a large set of patient scenarios rated by experts. According to the SLICC rule for the classification of SLE, the patient must satisfy at least 4 criteria, including at least one clinical criterion and one immunologic criterion OR the patient must have biopsy-proven lupus nephritis in the presence of antinuclear antibodies or anti-double-stranded DNA antibodies.

23 Article Seizure disorders in systemic lupus erythematosus results from an international, prospective, inception cohort study. 2012

Hanly, John G / Urowitz, Murray B / Su, Li / Gordon, Caroline / Bae, Sang-Cheol / Sanchez-Guerrero, Jorge / Romero-Diaz, Juanita / Wallace, Daniel J / Clarke, Ann E / Ginzler, Em / Merrill, Joan T / Isenberg, David A / Rahman, Anisur / Petri, M / Fortin, Paul R / Gladman, Dd / Bruce, Ian N / Steinsson, Kristjan / Dooley, Ma / Khamashta, Munther A / Alarcón, Graciela S / Fessler, Barri J / Ramsey-Goldman, Rosalind / Manzi, Susan / Zoma, Asad A / Sturfelt, Gunnar K / Nived, Ola / Aranow, Cynthia / Mackay, Meggan / Ramos-Casals, Manuel / van Vollenhoven, Rf / Kalunian, Kenneth C / Ruiz-Irastorza, Guillermo / Lim, Sam / Kamen, Diane L / Peschken, Christine A / Inanc, Murat / Theriault, Chris / Thompson, Kara / Farewell, Vernon. ·Division of Rheumatology, Nova Scotia Rehabilitation Centre (2nd Floor), 1341 Summer Street, Halifax, Nova Scotia B3H 4K4, Canada. john.hanly@cdha.nshealth.ca ·Ann Rheum Dis · Pubmed #22492779.

ABSTRACT: OBJECTIVE: The aim of this study was to describe the frequency, attribution, outcome and predictors of seizures in systemic lupus erythematosus (SLE). METHODS: The Systemic Lupus International Collaborating Clinics, or SLICC, performed a prospective inception cohort study. Demographic variables, global SLE disease activity (SLE Disease Activity Index 2000), cumulative organ damage (SLICC/American College of Rheumatology Damage Index (SDI)) and neuropsychiatric events were recorded at enrolment and annually. Lupus anticoagulant, anticardiolipin, anti-β(2) glycoprotein-I, antiribosomal P and anti-NR2 glutamate receptor antibodies were measured at enrolment. Physician outcomes of seizures were recorded. Patient outcomes were derived from the SF-36 (36-Item Short Form Health Survey) mental component summary and physical component summary scores. Statistical analyses included Cox and linear regressions. RESULTS: The cohort was 89.4% female with a mean follow-up of 3.5±2.9 years. Of 1631 patients, 75 (4.6%) had ≥1 seizure, the majority around the time of SLE diagnosis. Multivariate analysis indicated a higher risk of seizures with African race/ethnicity (HR (CI): 1.97 (1.07 to 3.63); p=0.03) and lower education status (1.97 (1.21 to 3.19); p<0.01). Higher damage scores (without neuropsychiatric variables) were associated with an increased risk of subsequent seizures (SDI=1:3.93 (1.46 to 10.55); SDI=2 or 3:1.57 (0.32 to 7.65); SDI≥4:7.86 (0.89 to 69.06); p=0.03). There was an association with disease activity but not with autoantibodies. Seizures attributed to SLE frequently resolved (59/78 (76%)) in the absence of antiseizure drugs. There was no significant impact on the mental component summary or physical component summary scores. Antimalarial drugs in the absence of immunosuppressive agents were associated with reduced seizure risk (0.07 (0.01 to 0.66); p=0.03). CONCLUSION: Seizures occurred close to SLE diagnosis, in patients with African race/ethnicity, lower educational status and cumulative organ damage. Most seizures resolved without a negative impact on health-related quality of life. Antimalarial drugs were associated with a protective effect.

24 Article Risk factors for avascular bone necrosis in patients with systemic lupus erythematosus. 2012

Sayarlioglu, Mehmet / Yuzbasioglu, Nergis / Inanc, Murat / Kamali, Sevil / Cefle, Ayse / Karaman, Ozcan / Onat, Ahmet Mesut / Avan, Rustem / Cetin, Gozde Yildirm / Gul, Ahmet / Ocal, Lale / Aral, Orhan. ·Department of Rheumatology, Faculty of Medicine, Kahramanmaraş Sutcu Imam University, Kahramanmaraş, Turkey. sayarli@yahoo.com ·Rheumatol Int · Pubmed #20711782.

ABSTRACT: The objective was to investigate the predictive factors for avascular necrosis (AVN) of bone in patients with systemic lupus erythematosus (SLE). The records of 868 patients with SLE from four centers were reviewed retrospectively. Forty-nine patients with AVN were identified. A total of 154 patients with SLE who did not have clinically apparent AVN during the follow-up were evaluated as a control group. The demographic, clinical, laboratory and management characteristics of these two groups of patients were recorded according to predefined protocol and compared. The prevalence of AVN was detected 6% in our SLE population. The highest dose corticosteroid administered within 4 months and total cumulative prednisolone dose were significantly higher in the SLE patients with AVN. The use of cytotoxic agent significantly higher proportion of patients with AVN. AVN tends to develop more frequently in male gender and younger patients. Oral ulcer, pleuritis, Raynaud's phenomenon, cutaneous vasculitis, lymphadenopathy, autoimmune thyroiditis, peripheral neuropathy and Sjögren's syndrome were higher incidence in SLE patients with AVN. The bilateral femoral heads were the commonest site of involvement of AVN in our patients with SLE.

25 Article Serologic response to Epstein-Barr virus antigens in patients with systemic lupus erythematosus: a controlled study. 2012

Esen, Bahar Artım / Yılmaz, Gülden / Uzun, Sami / Ozdamar, Melda / Aksözek, Alper / Kamalı, Sevil / Türkoğlu, Salih / Gül, Ahmet / Ocal, Lale / Aral, Orhan / Inanç, Murat. ·Rheumatology Division, Internal Medicine Department, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. bahartimesen@gmail.com ·Rheumatol Int · Pubmed #20661740.

ABSTRACT: Previous studies showed a link between systemic lupus erythematosus (SLE) and Epstein-Barr virus (EBV) infection. We sought to determine the features of serologic response to EBV in SLE patients and whether this response differs from those of systemic sclerosis (SSc) and primary antiphospholipid syndrome (PAPS) patients as well as healthy individuals. Sera from 198 consecutive SLE patients have been tested to detect IgG antibodies to EA/D, EBNA-1, VCA P18 and for comparison, cytomegalovirus (CMV) using commercially available ELISA kits (Trinity Biotech, USA). Forty-six SSc patients and 38 PAPS patients were enrolled as diseased control groups and sixty-five individuals as healthy controls. Significantly more SLE (54%, P = 0.001, OR 5.77, 95% CI 2.8-11.6), SSc (41.3%, P = 0.005, OR 3.4, 95% CI 1.4-8.2) and PAPS sera (36.8%, P = 0.023, OR 2.86, 95% CI 1.14-7.22) reacted against EA/D than healthy controls (16.9%). The mean age of anti-EA/D-positive SLE patients was significantly higher, and their disease duration was longer compared to anti-EA/D-negative SLE patients (41 ± 14 vs. 33.8 ± 10.8 years, P < 0.001 and 100 ± 73 vs. 71 ± 62 months, P = 0.003). In SLE patients, EA/D reactivity was associated with Raynaud's phenomenon and the presence of any anti-ENA antibodies. Although it did not reach a statistical significance, anti-EBNA-1 reactivity was slightly lower in patients with SLE. The frequency of anti-CMV Ig G positivity was found significantly higher in SLE patients (100%) when compared to patients with SSc (95.7%), PAPS (94.7%) and healthy controls (95.4%) (P = 0.035, P = 0.025 and P = 0.015 respectively). Our results support the proposed link between EBV and SLE. The finding that SSc and PAPS patients also have increased frequency of anti-EA/D response has revealed that this immune interaction may not be unique to patients with SLE, and there may be a common mechanism involving EBV in these autoimmune diseases.

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