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Systemic Lupus Erythematosus: HELP
Articles by Murat Inanc
Based on 40 articles published since 2010
(Why 40 articles?)
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Between 2010 and 2020, M. Inanç wrote the following 40 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 Serum and urine TNF-like weak inducer of apoptosis, monocyte chemoattractant protein-1 and neutrophil gelatinase-associated lipocalin as biomarkers of disease activity in patients with systemic lupus erythematosus. 2020

Mirioglu, S / Cinar, S / Yazici, H / Ozluk, Y / Kilicaslan, I / Gul, A / Ocal, L / Inanc, M / Artim-Esen, B. ·Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. · Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey. · Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. · Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. · Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. ·Lupus · Pubmed #32041504.

ABSTRACT: OBJECTIVES: TNF-like weak inducer of apoptosis (TWEAK), monocyte chemoattractant protein-1 (MCP-1) and neutrophil gelatinase-associated lipocalin (NGAL) are proinflammatory cytokines/chemokines that are considered as potential biomarkers reflecting disease activity in systemic lupus erythematosus (SLE). In this study, we aimed to investigate the association of serum (s) and urine (u) levels of TWEAK, MCP-1 and NGAL with disease activity in both renal and extra-renal SLE. METHODS: Thirty active patients with SLE (15 renal and 15 extra-renal) were recruited. Thirty-one inactive patients with SLE (16 renal and 15 extra-renal), 14 patients with ANCA-associated vasculitis (AAV) all of whom had active renal involvement and 20 healthy volunteers were selected as control groups. Serum and urine levels of TWEAK, MCP-1 and NGAL were tested using ELISA. RESULTS: Serum and urine levels of TWEAK and NGAL were significantly higher in the active SLE group compared to the inactive SLE group (sTWEAK CONCLUSION: sTWEAK, uTWEAK, sNGAL and uNGAL are biomarkers showing disease activity in SLE. However, our results implicate that these biomarkers may not be specific for SLE, and can be elevated in patients with active renal involvement of AAV.

4 Article Neuropsychiatric events in systemic lupus erythematosus: a longitudinal analysis of outcomes in an international inception cohort using a multistate model approach. 2020

Hanly, John G / Urowitz, Murray B / Gordon, Caroline / Bae, Sang-Cheol / Romero-Diaz, Juanita / Sanchez-Guerrero, Jorge / Bernatsky, Sasha / Clarke, Ann E / Wallace, Daniel J / Isenberg, David A / Rahman, Anisur / Merrill, Joan T / Fortin, Paul R / Gladman, Dafna D / Bruce, Ian N / Petri, Michelle / Ginzler, Ellen M / Dooley, Mary Anne / Ramsey-Goldman, Rosalind / Manzi, Susan / Jönsen, Andreas / Alarcón, Graciela S / van Vollenhoven, Ronald F / Aranow, Cynthia / Mackay, Meggan / Ruiz-Irastorza, Guillermo / Lim, Sam / Inanc, Murat / Kalunian, Kenneth C / Jacobsen, Søren / Peschken, Christine A / Kamen, Diane L / Askanase, Anca / Farewell, Vernon. ·Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth ll Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada john.hanly@cdha.nshealth.ca. · Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. · Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. · Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea. · Instituto Nacional de Ciencias Medicas y Nutricion, Mexico City, Mexico. · Divisions of Rheumatology and Clinical Epidemiology, Department of medicine, McGill University, Montreal, Quebec, Canada. · Divisions of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. · Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. · Centre for Rheumatology Research, Department of Medicine, University College, London, UK. · Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA. · Division of Rheumatology, Department of Medicine, CHU de Québec, Université Laval, Quebec City, Quebec, Canada. · Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. · Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA. · Thurston Arthritis Research Centre, University of North Carolina, Chapel Hill, NC, USA. · Northwestern University and Feinberg School of Medicine, Chicago, IL, USA. · Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, PA, USA. · Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden. · Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. · Department of Rheumatology and Clinical Immunology, University Medical Centres, Amsterdam, The Netherlands. · Feinstein Institute for Medical Research, Manhasset, NY, USA. · Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain. · Emory University, Department of Medicine, Division of Rheumatology, Atlanta, Georgia, USA. · Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. · UCSD School of Medicine, La Jolla, CA, USA. · Copenhagen Lupus and Vasculitis Clinic, 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. · University of Manitoba, Winnipeg, Manitoba, Canada. · Medical University of South Carolina, Charleston, South Carolina, USA. · Hospital for Joint Diseases, NYU, Seligman Centre for Advanced Therapeutics, New York, NY, USA. · MRC Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK. ·Ann Rheum Dis · Pubmed #31915121.

ABSTRACT: OBJECTIVES: Using a reversible multistate model, we prospectively examined neuropsychiatric (NP) events for attribution, outcome and association with health-related quality of life (HRQoL), in an international, inception cohort of systemic lupus erythematosus (SLE) patients. METHODS: Annual assessments for 19 NP events attributed to SLE and non-SLE causes, physician determination of outcome and patient HRQoL (short-form (SF)-36 scores) were measured. Time-to-event analysis and multistate modelling examined the onset, recurrence and transition between NP states. RESULTS: NP events occurred in 955/1827 (52.3%) patients and 592/1910 (31.0%) unique events were attributed to SLE. In the first 2 years of follow-up the relative risk (95% CI) for SLE NP events was 6.16 (4.96, 7.66) and non-SLE events was 4.66 (4.01, 5.43) compared with thereafter. Patients without SLE NP events at initial assessment had a 74% probability of being event free at 10 years. For non-SLE NP events the estimate was 48%. The majority of NP events resolved over 10 years but mortality was higher in patients with NP events attributed to SLE (16%) versus patients with no NPSLE events (6%) while the rate was comparable in patients with non-SLE NP events (7%) compared with patients with no non-SLE events (6%). Patients with NP events had lower SF-36 summary scores compared with those without NP events and resolved NP states (p<0.001). CONCLUSIONS: NP events occur most frequently around the diagnosis of SLE. Although the majority of events resolve they are associated with reduced HRQoL and excess mortality. Multistate modelling is well suited for the assessment of NP events in SLE.

5 Article Peripheral Nervous System Disease in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. 2020

Hanly, John G / Li, Qiuju / Su, Li / Urowitz, Murray B / Gordon, Caroline / Bae, Sang-Cheol / Romero-Diaz, Juanita / Sanchez-Guerrero, Jorge / Bernatsky, Sasha / Clarke, Ann E / Wallace, Daniel J / Isenberg, David A / Rahman, Anisur / Merrill, Joan T / Fortin, Paul R / Gladman, Dafna D / Bruce, Ian N / Petri, Michelle / Ginzler, Ellen M / Dooley, M A / Steinsson, Kristjan / Ramsey-Goldman, Rosalind / Zoma, Asad A / Manzi, Susan / Nived, Ola / Jonsen, Andreas / Khamashta, Munther A / Alarcón, Graciela S / Svenungsson, Elisabet / van Vollenhoven, Ronald F / Aranow, Cynthia / Mackay, Meggan / Ruiz-Irastorza, Guillermo / Ramos-Casals, Manuel / Lim, S Sam / Inanc, Murat / Kalunian, Kenneth C / Jacobsen, Soren / Peschken, Christine A / Kamen, Diane L / Askanase, Anca / Theriault, Chris / Farewell, Vernon. ·Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada. · University of Cambridge, Cambridge, UK. · Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada. · University of Birmingham College of Medical and Dental Sciences, Birmingham, UK. · Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea. · Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico. · McGill University, Montreal, Quebec, Canada. · University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada. · Cedars-Sinai and University of California, Los Angeles School of Medicine. · University College London, London, UK. · Oklahoma Medical Research Foundation, Oklahoma City. · CHU de Québec and Université Laval, Québec City, Québec, Canada. · Arthritis Research UK Epidemiology Unit, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Centre, and Manchester University NHS Foundation Trust, Manchester, UK. · Johns Hopkins University School of Medicine, Baltimore, Maryland. · SUNY Downstate Medical Center, Brooklyn, New York. · University of North Carolina, Chapel Hill, North Carolina. · Landspitali University Hospital, Reykjavík, Iceland. · Northwestern University and Feinberg School of Medicine, Chicago, Illinois. · Hairmyres Hospital, East Kilbride, UK. · Allegheny Health Network, Pittsburgh, Pennsylvania. · Lund University, Lund, Sweden. · St. Thomas' Hospital and King's College London School of Medicine, London, UK. · University of Alabama at Birmingham. · Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. · Amsterdam University Medical Centers, Amsterdam, The Netherlands. · Feinstein Institute for Medical Research, Manhasset, New York. · Hospital Universitario Cruces and University of the Basque Country, Barakaldo, Spain. · Institut d'Investigacions Biomèdiques August Pi i Sunyer and Hospital Clínic de Barcelona, Barcelona, Spain. · Emory University School of Medicine, Atlanta, Georgia. · Istanbul University, Istanbul, Turkey. · University of California San Diego School of Medicine. · Rigshospitalet and Copenhagen University Hospital, Copenhagen, Denmark. · University of Manitoba, Winnipeg, Manitoba, Canada. · Medical University of South Carolina, Charleston. · NYU Langone Orthopedic Hospital, New York, New York. ·Arthritis Rheumatol · Pubmed #31390162.

ABSTRACT: OBJECTIVE: To determine the frequency, clinical characteristics, associations, and outcomes of different types of peripheral nervous system (PNS) disease in a multiethnic/multiracial, prospective inception cohort of systemic lupus erythematosus (SLE) patients. METHODS: Patients were evaluated annually for 19 neuropsychiatric (NP) events including 7 types of PNS disease. SLE disease activity, organ damage, autoantibodies, and patient and physician assessment of outcome were measured. Time to event and linear regressions were used as appropriate. RESULTS: Of 1,827 SLE patients, 88.8% were female, and 48.8% were white. The mean ± SD age was 35.1 ± 13.3 years, disease duration at enrollment was 5.6 ± 4.2 months, and follow-up was 7.6 ± 4.6 years. There were 161 PNS events in 139 (7.6%) of 1,827 patients. The predominant events were peripheral neuropathy (66 of 161 [41.0%]), mononeuropathy (44 of 161 [27.3%]), and cranial neuropathy (39 of 161 [24.2%]), and the majority were attributed to SLE. Multivariate Cox regressions suggested longer time to resolution in patients with a history of neuropathy, older age at SLE diagnosis, higher SLE Disease Activity Index 2000 scores, and for peripheral neuropathy versus other neuropathies. Neuropathy was associated with significantly lower Short Form 36 (SF-36) physical and mental component summary scores versus no NP events. According to physician assessment, the majority of neuropathies resolved or improved over time, which was associated with improvements in SF-36 summary scores for peripheral neuropathy and mononeuropathy. CONCLUSION: PNS disease is an important component of total NPSLE and has a significant negative impact on health-related quality of life. The outcome is favorable for most patients, but our findings indicate that several factors are associated with longer time to resolution.

6 Article Construction of a Frailty Index as a Novel Health Measure in Systemic Lupus Erythematosus. 2020

Legge, Alexandra / Kirkland, Susan / Rockwood, Kenneth / Andreou, Pantelis / Bae, Sang-Cheol / Gordon, Caroline / Romero-Diaz, Juanita / Sanchez-Guerrero, Jorge / Wallace, Daniel J / Bernatsky, Sasha / Clarke, Ann E / Merrill, Joan T / Ginzler, Ellen M / Fortin, Paul / Gladman, Dafna D / Urowitz, Murray B / Bruce, Ian N / Isenberg, David A / Rahman, Anisur / Alarcón, Graciela S / Petri, Michelle / Khamashta, Munther A / Dooley, M A / Ramsey-Goldman, Rosalind / Manzi, Susan / Zoma, Asad A / Aranow, Cynthia / Mackay, Meggan / Ruiz-Irastorza, Guillermo / Lim, S Sam / Inanc, Murat / van Vollenhoven, Ronald F / Jonsen, Andreas / Nived, Ola / Ramos-Casals, Manuel / Kamen, Diane L / Kalunian, Kenneth C / Jacobsen, Soren / Peschken, Christine A / Askanase, Anca / Hanly, John G. ·From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. · A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University. · From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. john.hanly@nshealth.ca. · A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University. john.hanly@nshealth.ca. ·J Rheumatol · Pubmed #30988130.

ABSTRACT: OBJECTIVE: To construct a Frailty Index (FI) as a measure of vulnerability to adverse outcomes among patients with systemic lupus erythematosus (SLE), using data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. METHODS: The SLICC inception cohort consists of recently diagnosed patients with SLE followed annually with clinical and laboratory assessments. For this analysis, the baseline visit was defined as the first study visit at which sufficient information was available for construction of an FI. Following a standard procedure, variables from the SLICC database were evaluated as potential health deficits. Selected health deficits were then used to generate a SLICC-FI. The prevalence of frailty in the baseline dataset was evaluated using established cutpoints for FI values. RESULTS: The 1683 patients with SLE (92.1% of the overall cohort) eligible for inclusion in the baseline dataset were mostly female (89%) with mean (SD) age 35.7 (13.4) years and mean (SD) disease duration 18.8 (15.7) months at baseline. Of 222 variables, 48 met criteria for inclusion in the SLICC-FI. Mean (SD) SLICC-FI was 0.17 (0.08) with a range from 0 to 0.51. At baseline, 27.1% (95% CI 25.0-29.2) of patients were classified as frail, based on SLICC-FI values > 0.21. CONCLUSION: The SLICC inception cohort permits feasible construction of an FI for use in patients with SLE. Even in a relatively young cohort of patients with SLE, frailty was common. The SLICC-FI may be a useful tool for identifying patients with SLE who are most vulnerable to adverse outcomes, but validation of this index is required prior to its use.

7 Article Autoimmune haemolytic anaemia and thrombocytopaenia in a single-centre cohort of patients with systemic lupus erythematosus from Turkey: clinical associations and effect on disease damage and survival. 2019

Artım-Esen, B / Çene, E / Şahinkaya, Y / Erdugan, M / Oğuz, E / Gül, A / Öcal, L / İnanç, M. ·Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. · Department of Statistics, Faculty of Arts and Sciences, Yıldız Technical University, Istanbul, Turkey. ·Lupus · Pubmed #31558101.

ABSTRACT: INTRODUCTION: Thrombocytopaenia and autoimmune haemolytic anaemia (AIHA) have considerable impact on prognosis in systemic lupus erythematosus (SLE). We investigated the frequencies of these haemocytopaenias, along with their associations and effect on outcome in a single-centre cohort of patients with SLE. METHODS: Demographic characteristics, clinical features, autoantibody profiles, damage and mortality data were compared between patients with and without each haematological abnormality. Variables displaying significant differences between the groups were entered into logistic regression. RESULTS: Ninety-three patients had AIHA and 215 had thrombocytopaenia. Both were associated with neuropsychiatric (NP) involvement, with each other, leucopaenia, antiphospholipid syndrome (APS) and antiphospholipid antibodies. More patients in both groups had organ damage, and their damage scores were higher. Association to NP damage was discernible. In addition, cardiovascular and renal damage and diabetes were more pronounced in patients with thrombocytopaenia. At logistic regression analysis, younger age, anticardiolipin antibody IgM positivity, leucopaenia and thrombocytopaenia were associated with AIHA whilst lupus anticoagulant activity, AIHA, leucopaenia, APS and NP involvement were associated with thrombocytopaenia. Among damage items, peripheral vascular damage, diabetes, NP damage, renal and ocular damage displayed significant associations with thrombocytopaenia, whereas none of the items did with AIHA. Patients with AIHA had significantly reduced survival rates at 10 and 20 years. CONCLUSIONS: We observed that AIHA and thrombocytopaenia were associated with severe lupus, affecting major organs and causing end organ damage. Thus, they may be considered as prognostic markers. Furthermore, AIHA and especially thrombocytopaenia may also be a marker for a subgroup of lupus patients who have or may develop APS.

8 Article Evaluating the Properties of a Frailty Index and Its Association With Mortality Risk Among Patients With Systemic Lupus Erythematosus. 2019

Legge, Alexandra / Kirkland, Susan / Rockwood, Kenneth / Andreou, Pantelis / Bae, Sang-Cheol / Gordon, Caroline / Romero-Diaz, Juanita / Sanchez-Guerrero, Jorge / Wallace, Daniel J / Bernatsky, Sasha / Clarke, Ann E / Merrill, Joan T / Ginzler, Ellen M / Fortin, Paul / Gladman, Dafna D / Urowitz, Murray B / Bruce, Ian N / Isenberg, David A / Rahman, Anisur / Alarcón, Graciela S / Petri, Michelle / Khamashta, Munther A / Dooley, M A / Ramsey-Goldman, Rosalind / Manzi, Susan / Steinsson, Kristjan / Zoma, Asad A / Aranow, Cynthia / Mackay, Meggan / Ruiz-Irastorza, Guillermo / Lim, S Sam / Inanc, Murat / van Vollenhoven, Ronald F / Jonsen, Andreas / Nived, Ola / Ramos-Casals, Manuel / Kamen, Diane L / Kalunian, Kenneth C / Jacobsen, Soren / Peschken, Christine A / Askanase, Anca / Hanly, John G. ·Dalhousie University, Halifax, Nova Scotia, Canada. · Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea. · University of Birmingham, Birmingham, UK. · Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico. · Cedars-Sinai Medical Center and David Geffen School of Medicine at University of California, Los Angeles. · McGill University, Montreal, Quebec, Canada. · University of Calgary, Calgary, Alberta, Canada. · Oklahoma Medical Research Foundation, Oklahoma City. · SUNY Downstate Medical Center, Brooklyn, New York. · CHU de Québec et Université Laval, Quebec City, Canada. · Toronto Western Hospital and University of Toronto, Ontario, Canada. · University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK. · University College London, London, UK. · University of Alabama at Birmingham. · Johns Hopkins University School of Medicine, Baltimore, Maryland. · St Thomas' Hospital, King's College London School of Medicine, London, UK. · University of North Carolina, Chapel Hill. · Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Allegheny Health Network, Pittsburgh, Pennsylvania. · Landspitali University Hospital, Reykjavik, Iceland. · Hairmyres Hospital, East Kilbride, Scotland, UK. · Feinstein Institute for Medical Research, Manhasset, New York. · Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain. · Emory University School of Medicine, Atlanta, Georgia. · Istanbul University, Istanbul, Turkey. · Karolinska Institute, Stockholm, Sweden. · Lund University, Lund, Sweden. · Hospital Clínic de Barcelona, Barcelona, Spain. · Medical University of South Carolina, Charleston. · University of California San Diego School of Medicine, La Jolla. · Copenhagen University Hospital, Copenhagen, Denmark. · University of Manitoba, Winnipeg, Manitoba, Canada. · Hospital for Joint Diseases, New York University, New York. · Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada. ·Arthritis Rheumatol · Pubmed #30771242.

ABSTRACT: OBJECTIVE: To evaluate the properties of a frailty index (FI), constructed using data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort, as a novel health measure in systemic lupus erythematosus (SLE). METHODS: For this secondary analysis, the baseline visit was defined as the first study visit at which both organ damage (SLICC/American College of Rheumatology Damage Index [SDI]) and health-related quality of life (Short-Form 36 [SF-36] scores) were assessed. The SLICC-FI was constructed using baseline data. The SLICC-FI comprises 48 health deficits, including items related to organ damage, disease activity, comorbidities, and functional status. Content, construct, and criterion validity of the SLICC-FI were assessed. Multivariable Cox regression was used to estimate the association between baseline SLICC-FI values and mortality risk, adjusting for demographic and clinical factors. RESULTS: In the baseline data set of 1,683 patients with SLE, 89% were female, the mean ± SD age was 35.7 ± 13.4 years, and the mean ± SD disease duration was 18.8 ± 15.7 months. At baseline, the mean ± SD SLICC-FI score was 0.17 ± 0.08 (range 0-0.51). Baseline SLICC-FI values exhibited the expected measurement properties and were weakly correlated with baseline SDI scores (r = 0.26, P < 0.0001). Higher baseline SLICC-FI values (per 0.05 increment) were associated with increased mortality risk (hazard ratio 1.59, 95% confidence interval 1.35-1.87), after adjusting for age, sex, steroid use, ethnicity/region, and baseline SDI scores. CONCLUSION: The SLICC-FI demonstrates internal validity as a health measure in SLE and might be used to predict future mortality risk. The SLICC-FI is potentially valuable for quantifying vulnerability among patients with SLE, and adds to existing prognostic scores.

9 Article Use of combined hormonal contraceptives among women with systemic lupus erythematosus with and without medical contraindications to oestrogen. 2019

Mendel, Arielle / Bernatsky, Sasha / Pineau, Christian A / St-Pierre, Yvan / Hanly, John G / Urowitz, Murray B / Clarke, Ann E / Romero-Diaz, Juanita / Gordon, Caroline / Bae, Sang-Cheol / 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, Kristján / Ramsey-Goldman, Rosalind / Khamashta, Munther A / Aranow, Cynthia / Mackay, Meggan / Alarcón, Graciela / Manzi, Susan / Nived, Ola / Jönsen, Andreas / Zoma, Asad A / van Vollenhoven, Ronald F / Ramos-Casals, Manuel / Ruiz-Irastorza, Giuillermo / Lim, Sam / Kalunian, Kenneth C / Inanc, Murat / Kamen, Diane L / Peschken, Christine A / Jacobsen, Søren / Askanase, Anca / Sanchez-Guerrero, Jorge / Bruce, Ian N / Costedoat-Chalumeau, Nathalie / Vinet, Evelyne. ·Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada. · Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, 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. · Centre for Prognosis Studies in the Rheumatic Disease and Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. · Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. · Division of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición, 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. · 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, New York, 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, Quebec, 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, 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. · Joseph 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. · Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. · Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. · Copenhagen Lupus and Vasculitis Clinic, Section 4242, Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. · Division of Rheumatology, Columbia University Medical Center, New York, NY, USA. · Department of Rheumatology, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada. · Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal and Dermatological Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. · NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. · Centre de Reference Maladies Auto-immunes et Systemiques Rares, Service de Medecine Interne, Hospital Cochin, Paris, France. ·Rheumatology (Oxford) · Pubmed #30753683.

ABSTRACT: OBJECTIVES: To assess the prevalence of combined hormonal contraceptives (CHCs) in reproductive-age women with SLE with and without possible contraindications and to determine factors associated with their use in the presence of possible contraindications. METHODS: This observational cohort study included premenopausal women ages 18-45 years enrolled in the SLICC Registry ⩽15 months after SLE onset, with annual assessments spanning 2000-2017. World Health Organization Category 3 or 4 contraindications to CHCs (e.g. hypertension, aPL) were assessed at each study visit. High disease activity (SLEDAI score >12 or use of >0.5 mg/kg/day of prednisone) was considered a relative contraindication. RESULTS: A total of 927 SLE women contributed 6315 visits, of which 3811 (60%) occurred in the presence of one or more possible contraindication to CHCs. Women used CHCs during 512 (8%) visits, of which 281 (55%) took place in the setting of one or more possible contraindication. The most frequently observed contraindications were aPL (52%), hypertension (34%) and migraine with aura (22%). Women with one or more contraindication were slightly less likely to be taking CHCs [7% of visits (95% CI 7, 8)] than women with no contraindications [9% (95% CI 8, 10)]. CONCLUSION: CHC use was low compared with general population estimates (>35%) and more than half of CHC users had at least one possible contraindication. Many yet unmeasured factors, including patient preferences, may have contributed to these observations. Further work should also aim to clarify outcomes associated with this exposure.

10 Article Osteopontin and Disease Activity in Patients with Recent-onset Systemic Lupus Erythematosus: Results from the SLICC Inception Cohort. 2019

Wirestam, Lina / Enocsson, Helena / Skogh, Thomas / Padyukov, Leonid / Jönsen, Andreas / Urowitz, Murray B / Gladman, Dafna D / Romero-Diaz, Juanita / Bae, Sang-Cheol / Fortin, Paul R / Sanchez-Guerrero, Jorge / Clarke, Ann E / Bernatsky, Sasha / Gordon, Caroline / Hanly, John G / Wallace, Daniel / Isenberg, David A / Rahman, Anisur / Merrill, Joan / Ginzler, Ellen / Alarcón, Graciela S / Chatham, W Winn / Petri, Michelle / Khamashta, Munther / Aranow, Cynthia / Mackay, Meggan / Dooley, Mary Anne / Manzi, Susan / Ramsey-Goldman, Rosalind / Nived, Ola / Steinsson, Kristjan / Zoma, Asad / Ruiz-Irastorza, Guillermo / Lim, Sam / Kalunian, Ken / Inanc, Murat / van Vollenhoven, Ronald / Ramos-Casals, Manuel / Kamen, Diane L / Jacobsen, Søren / Peschken, Christine / Askanase, Anca / Stoll, Thomas / Bruce, Ian N / Wetterö, Jonas / Sjöwall, Christopher. ·From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland. lina.wirestam@gmail.com. · L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University. lina.wirestam@gmail.com. · From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland. · L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University. ·J Rheumatol · Pubmed #30647177.

ABSTRACT: OBJECTIVE: In cross-sectional studies, elevated osteopontin (OPN) levels have been proposed to reflect, and/or precede, progressive organ damage and disease severity in systemic lupus erythematosus (SLE). We aimed, in a cohort of patients with recent-onset SLE, to determine whether raised serum OPN levels precede damage and/or are associated with disease activity or certain disease phenotypes. METHODS: We included 344 patients from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort who had 5 years of followup data available. All patients fulfilled the 1997 American College of Rheumatology (ACR) criteria. Baseline sera from patients and from age- and sex-matched population-based controls were analyzed for OPN using ELISA. Disease activity and damage were assessed at each annual followup visit using the SLE Disease Activity Index 2000 (SLEDAI-2K) and the SLICC/ACR damage index (SDI), respectively. RESULTS: Compared to controls, baseline OPN was raised 4-fold in SLE cases (p < 0.0001). After relevant adjustments in a binary logistic regression model, OPN levels failed to significantly predict global damage accrual defined as SDI ≥ 1 at 5 years. However, baseline OPN correlated with SLEDAI-2K at enrollment into the cohort (r = 0.27, p < 0.0001), and patients with high disease activity (SLEDAI-2K ≥ 5) had raised serum OPN (p < 0.0001). In addition, higher OPN levels were found in patients with persistent disease activity (p = 0.0006), in cases with renal involvement (p < 0.0001) and impaired estimated glomerular filtration rate (p = 0.01). CONCLUSION: The performance of OPN to predict development of organ damage was not impressive. However, OPN associated significantly with lupus nephritis and with raised disease activity at enrollment, as well as over time.

11 Article Psychosis in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. 2019

Hanly, John G / Li, Qiuju / Su, Li / Urowitz, Murray B / Gordon, Caroline / Bae, Sang-Cheol / Romero-Diaz, Juanita / Sanchez-Guerrero, Jorge / Bernatsky, Sasha / Clarke, Ann E / Wallace, Daniel J / Isenberg, David A / Rahman, Anisur / Merrill, Joan T / Fortin, Paul R / Gladman, Dafna D / Bruce, Ian N / Petri, Michelle / Ginzler, Ellen M / Dooley, M A / Steinsson, Kristjan / Ramsey-Goldman, Rosalind / Zoma, Asad A / Manzi, Susan / Nived, Ola / Jonsen, Andreas / Khamashta, Munther A / Alarcón, Graciela S / van Vollenhoven, Ronald F / Aranow, Cynthia / Mackay, Meggan / Ruiz-Irastorza, Guillermo / Ramos-Casals, Manuel / Lim, S Sam / Inanc, Murat / Kalunian, Kenneth C / Jacobsen, Soren / Peschken, Christine A / Kamen, Diane L / Askanase, Anca / Theriault, Chris / Farewell, Vernon. ·Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada. · University of Cambridge, Cambridge, UK. · Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada. · University of Birmingham, Birmingham, UK. · Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea. · Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico. · McGill University, Montreal, Quebec, Canada. · University of Calgary, Calgary, Alberta, Canada. · Cedars-Sinai Medical Center and David Geffen School of Medicine at University of California, Los Angeles. · University College London, London, UK. · Oklahoma Medical Research Foundation, Oklahoma City. · CHU de Québec, Université Laval, Quebec City, Quebec, Canada. · University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK. · Johns Hopkins University School of Medicine, Baltimore, Maryland. · SUNY Downstate Medical Center, Brooklyn, New York. · University of North Carolina, Chapel Hill. · Landspitali University Hospital, Reykjavik, Iceland. · Northwestern University, Chicago, Illinois. · Hairmyres Hospital, East Kilbride, Scotland, UK. · Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania. · Lund University, Lund, Sweden. · St Thomas' Hospital, King's College London School of Medicine, London, UK. · University of Alabama at Birmingham. · Karolinska Institute, Stockholm, Sweden. · Feinstein Institute for Medical Research, Manhasset, New York. · Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain. · Hospital Clínic, Barcelona, Spain. · Emory University School of Medicine, Atlanta, Georgia. · Istanbul University, Istanbul, Turkey. · University of California San Diego School of Medicine, La Jolla. · Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. · University of Manitoba, Winnipeg, Manitoba, Canada. · Medical University of South Carolina, Charleston. · Hospital for Joint Diseases, New York University, New York, New York. ·Arthritis Rheumatol · Pubmed #30375754.

ABSTRACT: OBJECTIVE: To determine, in a large, multiethnic/multiracial, prospective inception cohort of patients with systemic lupus erythematosus (SLE), the frequency, attribution, clinical, and autoantibody associations with lupus psychosis and the short- and long-term outcomes as assessed by physicians and patients. METHODS: Patients were evaluated annually for 19 neuropsychiatric (NP) events including psychosis. Scores on the Systemic Lupus Erythematosus Disease Activity Index 2000, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, and the Short Form 36 (SF-36) were recorded. Time to event and linear regressions were used as appropriate. RESULTS: Of 1,826 SLE patients, 88.8% were female and 48.8% were Caucasian. The mean ± SD age was 35.1 ± 13.3 years, the mean ± SD disease duration was 5.6 ± 4.2 months, and the mean ± SD follow-up period was 7.4 ± 4.5 years. There were 31 psychotic events in 28 of 1,826 patients (1.53%), and most patients had a single event (26 of 28 [93%]). In the majority of patients (20 of 25 [80%]) and events (28 of 31 [90%]), psychosis was attributed to SLE, usually either in the year prior to or within 3 years of SLE diagnosis. Positive associations (hazard ratios [HRs] and 95% confidence intervals [95% CIs]) with lupus psychosis were previous SLE NP events (HR 3.59 [95% CI 1.16-11.14]), male sex (HR 3.0 [95% CI 1.20-7.50]), younger age at SLE diagnosis (per 10 years) (HR 1.45 [95% CI 1.01-2.07]), and African ancestry (HR 4.59 [95% CI 1.79-11.76]). By physician assessment, most psychotic events resolved by the second annual visit following onset, in parallel with an improvement in patient-reported SF-36 summary and subscale scores. CONCLUSION: Psychosis is an infrequent manifestation of NPSLE. Generally, it occurs early after SLE onset and has a significant negative impact on health status. As determined by patient and physician report, the short- and long-term outlooks are good for most patients, although careful follow-up is required.

12 Article Antinuclear Antibody-Negative Systemic Lupus Erythematosus in an International Inception Cohort. 2019

Choi, May Y / Clarke, Ann E / St Pierre, Yvan / Hanly, John G / Urowitz, Murray B / Romero-Diaz, Juanita / Gordon, Caroline / Bae, Sang-Cheol / Bernatsky, Sasha / Wallace, Daniel J / Merrill, Joan T / Isenberg, David A / Rahman, Anisur / Ginzler, Ellen M / Petri, Michelle / Bruce, Ian N / Dooley, Mary A / Fortin, Paul R / Gladman, Dafna D / Sanchez-Guerrero, Jorge / Steinsson, Kristjan / Ramsey-Goldman, Rosalind / Khamashta, Munther A / Aranow, Cynthia / Alarcón, Graciela S / Manzi, Susan / Nived, Ola / 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 / Stoll, Thomas / Buyon, Jill / Mahler, Michael / Fritzler, Marvin J. ·University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada. · McGill University Health Centre, Montreal, Quebec, Canada. · Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada. · Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. · Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico. · University of Birmingham, Birmingham, UK. · Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea. · Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles. · 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, University of Manchester, NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, and Manchester Academic Health Science Centre, Manchester, UK. · University of North Carolina, Chapel Hill. · CHU de Québec-Université Laval, Quebec City, Quebec, Canada. · Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada. · Landspitali University Hospital, Reykjavik, Iceland. · Northwestern University and Feinberg School of Medicine, Chicago, Illinois. · 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. · Allegheny Health Network, Pittsburgh, Pennsylvania. · University Hospital Lund, Lund, Sweden. · Hairmyres Hospital, East Kilbride, Scotland, UK. · University of Amsterdam, Amsterdam, The Netherlands. · Hospital Clínic, Barcelona, Spain. · Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain. · Emory University School of Medicine, Atlanta, Georgia. · University of California San Diego School of Medicine, 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 and New York University, New York. · Kantousspital, Schaffhausen, Switzerland. · New York University School of Medicine, New York. · Inova Diagnostics Inc., San Diego, California. ·Arthritis Care Res (Hoboken) · Pubmed #30044551.

ABSTRACT: OBJECTIVE: The spectrum of antinuclear antibodies (ANAs) is changing to include both nuclear staining as well as cytoplasmic and mitotic cell patterns (CMPs) and accordingly a change is occurring in terminology to anticellular antibodies. This study examined the prevalence of indirect immunofluorescence (IIF) anticellular antibody staining using the Systemic Lupus International Collaborating Clinics inception cohort. METHODS: Anticellular antibodies were detected by IIF on HEp-2000 substrate using the baseline serum. Three serologic subsets were examined: ANA positive (presence of either nuclear or mixed nuclear/CMP staining), anticellular antibody negative (absence of any intracellular staining), and isolated CMP staining. The odds of being anticellular antibody negative versus ANA or isolated CMP positive was assessed by multivariable analysis. RESULTS: A total of 1,137 patients were included; 1,049 (92.3%) were ANA positive, 71 (6.2%) were anticellular antibody negative, and 17 (1.5%) had an isolated CMP. The isolated CMP-positive group did not differ from the ANA-positive or anticellular antibody-negative groups in clinical, demographic, or serologic features. Patients who were older (odds ratio [OR] 1.02 [95% confidence interval (95% CI) 1.00, 1.04]), of white race/ethnicity (OR 3.53 [95% CI 1.77, 7.03]), or receiving high-dose glucocorticoids at or prior to enrollment (OR 2.39 [95% CI 1.39, 4.12]) were more likely to be anticellular antibody negative. Patients on immunosuppressants (OR 0.35 [95% CI 0.19, 0.64]) or with anti-SSA/Ro 60 (OR 0.41 [95% CI 0.23, 0.74]) or anti-U1 RNP (OR 0.43 [95% CI 0.20, 0.93]) were less likely to be anticellular antibody negative. CONCLUSION: In newly diagnosed systemic lupus erythematosus, 6.2% of patients were anticellular antibody negative, and 1.5% had an isolated CMP. The prevalence of anticellular antibody-negative systemic lupus erythematosus will likely decrease as emerging nomenclature guidelines recommend that non-nuclear patterns should also be reported as a positive ANA.

13 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

14 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.

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

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

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

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

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

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

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

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

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

18 Article 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.

19 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.

20 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.

21 Article Off-label use of rituximab for systemic lupus erythematosus in Europe. 2016

Rydén-Aulin, Monica / Boumpas, Dimitrios / Bultink, Irene / Callejas Rubio, Jose Luis / Caminal-Montero, Luis / Castro, Antoni / Colodro Ruiz, Agustín / Doria, Andrea / Dörner, Thomas / Gonzalez-Echavarri, Cristina / Gremese, Elisa / Houssiau, Frederic A / Huizinga, Tom / Inanç, Murat / Isenberg, David / Iuliano, Annamaria / Jacobsen, Søren / Jimenéz-Alonso, Juan / Kovács, Lászlo / Mariette, Xavier / Mosca, Marta / Nived, Ola / Oristrell, Joaquim / Ramos-Casals, Manuel / Rascón, Javier / Ruiz-Irastorza, Guillermo / Sáez-Comet, Luis / Salvador Cervelló, Gonzalo / Sebastiani, Gian Domenico / Squatrito, Danilo / Szücs, Gabriella / Voskuyl, Alexandre / van Vollenhoven, Ronald. ·Unit of Clinical Therapy Research, Inflammatory Diseases, Department of Medicine , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden. · Joint Academic Rheumatology Program and 4th Department of Medicine , Medical School, National and Kapodestrian University of Athens, Attikon University Hospital , Athens , Greece. · Department of Rheumatology , Amsterdam Rheumatology and Immunology Center , Amsterdam , The Netherlands. · Unit of Autoimmune Diseases , Hospital San Cecilio , Granada , Spain. · Autoimmune Systemic Diseases Unit, Internal Medicine Department , Hospital Universitario Central de Asturias , Oviedo , Spain. · Internal Medicine Department , University Hospital Sant Joan de Reus, Rovira i Virgili University (URV)-IISPV , Reus , Spain. · Pasaje Nueva Victoria, 2, 2do C , Jaén , Spain. · Rheumatology Unit, Department of Medicine , University of Padova , Padova , Italy. · Department of Medicine/Rheumatology and Clinical Immunology , Charite Universitaetsmedizin Berlin , Berlin , Germany. · Autoimmune Diseases Research Unit, Department of Internal Medicine , BioCruces Health Research Institute, Cruces University Hospital, University of the Basque Country , Barakaldo , Spain. · Institute of Rheumatology and Affine Sciences (IRSA), Catholic University of the Sacred Heart , Rome , Italy. · Service de Rhumatologie , Cliniques Universitaires Saint-Luc, Pôle de Pathologies Rhumatismales Inflammatoires et Systémiques, Université Catholique de Louvain , Brussels , Belgium. · Department of Rheumatology , C1-41, Leiden University Medical Center , Leiden , The Netherlands. · Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University , Istanbul , Turkey. · University College London, The Rayne Building , London , UK. · Rheumatology Unit , San Camillo Hospital , Rome , Italy. · Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, University of Copenhagen, Rigshospitalet , Copenhagen , Denmark. · Internal Department , Universitary 'Virgen de las Nieves' Hospital , Granada , Spain. · Department of Rheumatology, Faculty of Medicine , Albert Szent-Györgyi Health Centre, University of Szeged , Szeged , Hungary. · Rhumatologie Responsable de l'Unité de Recherche Clinique, Hôpitaux Universitaire Paris-Sud, Université Paris-Sud, INSERM U1184 , Paris , France. · Rheumatology Unit, Pisa , Italy. · Rheumatology Clinic, Skåne University Hospital , Lund , Sweden. · Internal Medicine Department , Hospital de Sabadell, Universitat Autonoma de Barcelona , Catalunya , Spain. · Department of Autoimmune Diseases , ICMiD, Josep Font Autoimmune Lab, CELLEX-IDIBAPS , Barcelona , Spain. · Carrer de les Sabateres, 9-1, Alaró , Islas Baleares , Spain. · Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Universitario Miguel Servet de Zaragoza, Paseo Isabel la Católica , Zaragoza , Spain. · Department of Internal Medicine, Inmunopathological and Autoimmune Area , Hospital Universitario y Politecnico La Fe , Valencia , Spain. · UOC Reumatologia, Ospedale San Camillo, Circonvallazione Gianicolense n. 87 , Roma , Italy. · Department of Sperimental and Clinical Medicine , University of Florence , Firenze , Italy. · Department of Rheumatology , Institute of Medicine, University of Debrecen , Debrecen , Hungary. · Amsterdam Rheumatology and Immunology Center (ARC), VU University Medical Center , Amsterdam , The Netherlands. · Unit of Clinical Therapy Research, Inflammatory Diseases, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Rheumatology Clinic, Karolinska University Hospital, Stockholm, Sweden; Amsterdam Rheumatology and Immunology Center ARC, AMC mail F4-105, Amsterdam, The Netherlands. ·Lupus Sci Med · Pubmed #27651920.

ABSTRACT: OBJECTIVES: Rituximab (RTX) is a biological treatment used off-label in patients with systemic lupus erythematosus (SLE). This survey aimed to investigate the off-label use of RTX in Europe and compare the characteristics of patients receiving RTX with those receiving conventional therapy. METHODS: Data on patients with SLE receiving RTX were taken from the International Registry for Biologics in SLE retrospective registry and complemented with data on patients with SLE treated with conventional therapy. For nationwide estimates of RTX use in patients with SLE, investigators were asked to provide data through case report forms (CRFs). Countries for which no data were submitted through CRFs, published literature and/or personal communication were used, and for European countries where no data were available, estimates were made on the assumption of similarities with neighbouring countries. RESULTS: The estimated off-label use of RTX in Europe was 0.5%-1.5% of all patients with SLE. In comparison with patients with SLE on conventional therapy, patients treated with RTX had longer disease duration, higher disease activity and were more often treated with immunosuppressives. The most frequent organ manifestations for which either RTX or conventional therapy was initiated were lupus nephritis followed by musculoskeletal and haematological. The reason for treatment was, besides disease control, corticosteroid-sparing for patients treated with conventional therapy. CONCLUSIONS: RTX use for SLE in Europe is restrictive and appears to be used as a last resort in patients for whom other reasonable options have been exhausted.

22 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.

23 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.

24 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.

25 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.

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