Switching treatment between mycophenolate mofetil and azathioprine in lupus patients: indications and outcomes.

Objective: To determine the reasons for changing treatment from mycophenolate mofetil (MMF) to azathioprine (AZA) or vice versa in lupus patients and to evaluate the effect of the change.

Methods: Lupus patients were identified from the University of Toronto Lupus Clinic database. Global disease activity in the 6 months prior to the change in therapy and 6 months after the change was calculated.

Time to recovery from proteinuria in patients with lupus nephritis receiving standard treatment.

Objective: The recovery time from abnormal levels of proteinuria with standard treatment in longitudinal studies of patients with systemic lupus erythematosus has not been well described. We aimed (1) to determine the recovery time from proteinuria in patients with lupus nephritis (LN) receiving standard treatment, and (2) to determine whether the initial level of proteinuria predicts time to improvement.

Methods: We studied all patients with LN recorded in the database from 1970 until 2011.

Assessment of coronary risk based on cumulative exposure to lipids in systemic lupus erythematosus.

Objective: To quantify the independent role of each of low-density lipoprotein cholesterol (LDL-C), total cholesterol:high-density lipoprotein cholesterol ratio (TC:HDL-C), triglyceride (TG) level, and HDL-C as a marker of coronary risk in systemic lupus erythematosus (SLE).

Methods: Patients with lipid measurements taken before a coronary event (or last clinic visit) were included. Mean and time-adjusted mean (TAM) levels were calculated for each lipid variable in each patient.

Damage in lupus patients--what have we learned so far?

With the improvement of survival of systemic lupus erythematosus (SLE) patients, prevention of organ damage has become a major goal in the management of these patients. The need for a reliable tool for assessment of cumulative damage over time led to the development of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI) that allowed a standardized measurement of damage and facilitated research in the field. Damage accumulates over the course of the disease; however, some patients do not accrue any damage even after many years.

Recommendations for frequency of visits to monitor systemic lupus erythematosus in asymptomatic patients: data from an observational cohort study.

Objective: The aim of our study was to determine the optimal frequency of followup visits in patients with systemic lupus erythematosus (SLE).

Methods: Patients followed in the lupus clinic over a 2-year period who had at least 3 visits and at least 18 months of followup were included. At each visit patients undergo a complete history, physical examination, and laboratory evaluation.

Vaccination and auto-immune rheumatic diseases: lessons learnt from the 2009 H1N1 influenza virus vaccination campaign.

Purpose Of Review: To determine the safety and efficacy of adjuvant and nonadjuvant influenza A/H1NI vaccination in patients with rheumatic diseases.

Recent Findings: Due to immune abnormalities and the use of steroids and immunosuppressant treatment, patients with rheumatic diseases are susceptible to infections including influenza. Infections continue to be one of the leading causes of morbidity and mortality in rheumatic diseases, partly due to the disease processes and partly due to medications.

SLEDAI-2K Responder Index 50 captures 50% improvement in disease activity over 10 years.

Objectives: To determine the frequency and the time to complete recovery identified by Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and the time to partial recovery identified by the SLEDAI-2K Responder Index 50 (SRI-50) in three laboratory systems over 10 years.

Methods: This is a retrospective analysis of the data available from the Toronto Lupus Clinic over the last 10 years. Patients with SLEDAI-2K renal, immunological and hematologic active descriptors were identified.

Systemic lupus erythematosus disease activity Index 2000 Responder Index 50: sensitivity to response at 6 and 12 months.

Objective: The SLEDAI 2000 (SLEDAI-2K) Responder Index 50 (SRI-50) is a novel index that measures ≥ 50% in each of the 24 descriptors of SLEDAI-2K and generates a total score reflecting disease activity overall. The SLE Responder Index (SRI) has been successfully used to identify responders in recent trials. This is the first study to evaluate the ability of SRI-50 to identify responders, defined as patients who had a clinically important improvement over their baseline value over 12 months.

Outcomes in patients with systemic lupus erythematosus with and without a prolonged serologically active clinically quiescent period.

Objective: Serologically active clinically quiescent (SACQ) systemic lupus erythematosus (SLE) patients' discordance presents a clinical dilemma. Does active serology alone warrant treatment? We explore outcomes in patients with and without a prolonged SACQ period, comparing the rate of damage accrual by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) and incidences of renal damage and coronary artery disease (CAD) over a decade.

Methods: SACQ was defined as a ≥2-year sustained period without clinical activity, with persistent serologic activity (increased anti-double-stranded DNA and/or hypocomplementemia).

Autoantibody response to adjuvant and nonadjuvant H1N1 vaccination in systemic lupus erythematosus.

Objective: It has been reported that influenza vaccination increases autoantibody production and/or disease activity in a significant proportion of patients with systemic lupus erythematosus (SLE). During the recent H1N1 epidemic, we investigated whether the use of adjuvant- and nonadjuvant-containing H1N1 vaccine induced increased autoantibody production in patients with SLE.

Methods: Patients with SLE who received H1N1 vaccination and had a battery of 9 autoantibodies tested before and 1 and 3 months after vaccination were included.

Importance of cumulative exposure to elevated cholesterol and blood pressure in development of atherosclerotic coronary artery disease in systemic lupus erythematosus: a prospective proof-of-concept cohort study.

Introduction: Previous studies have shown that traditional risk factors such as hypercholesterolemia and hypertension account for only a small proportion of the dramatically increased risk of atherosclerotic coronary artery disease (CAD) in systemic lupus erythematosus (SLE). However, in these studies, exposure to risk factors was measured only at baseline. In this study, our objective was to compare measures of cumulative exposure with remote and recent values for each of total cholesterol (TC), systolic (SBP), and diastolic (DBP) blood pressure in terms of ability to quantify risk of atherosclerotic CAD in patients with SLE.

Systemic Lupus Erythematosus Disease Activity Index 2000 Responder Index-50 enhances the ability of SLE Responder Index to identify responders in clinical trials.

Objective: To evaluate the performance of the Systemic Lupus Erythematosus (SLE) Responder Index (SRI) when the SLE Disease Activity Index 2000 (SLEDAI-2K) is substituted with SLEDAI-2K Responder Index-50 (SRI-50), a valid and reliable index of disease activity improvement. Also, to determine whether the SRI-50 will enhance the ability of SRI in detecting responders.

Methods: Our study was conducted on patients who attended the Lupus Clinic from September 2009 to September 2010.

Relationship between cardiac symptoms, myocardial perfusion defects and coronary angiography findings in systemic lupus erythematosus.

Coronary angiography is generally regarded as the 'gold standard' test for diagnosing coronary artery disease (CAD). We sought to determine the relationship between cardiac symptoms and findings of coronary angiography and myocardial perfusion scintigraphy (MPS) in patients with systemic lupus erythematosus (SLE). Medical records of all SLE patients who underwent coronary angiography while attending our clinic over 24 years were reviewed, noting the indication for the test and its findings.

Optimal frequency of visits for patients with systemic lupus erythematosus to measure disease activity over time.

Objective: adjusted mean Systemic Lupus Erythematosus Disease Activity Index (SLEDAI; AMS) measures lupus disease activity over time. Our aim was to determine optimal visit frequency for calculating AMS.

Methods: patients followed monthly for 12 consecutive visits were included.

Mycophenolate mofetil for induction treatment of lupus nephritis: a systematic review and metaanalysis.

Objective: to systematically review the efficacy and safety of mycophenolic acid and mycophenolate mofetil (MMF) compared to cyclophosphamide (CYC) for the induction treatment of lupus nephritis (LN).

Methods: medline, Embase, the Cochrane Center Register of Controlled Trials, and abstracts presented in major international conferences were searched for randomized controlled trials. The primary outcome was renal remission (complete, partial, and overall) and secondary outcomes were adverse events during study period and longterm followup data.

Burden of autoantibodies and association with disease activity and damage in systemic lupus erythematosus.

Objectives: To determine whether immunological burden of autoantibodies as reflected by the number of cumulative antibodies present at inception and after 3 and 5 years is associated with or predicts subsequent disease activity and damage in lupus.

Methods: Patients with SLE followed from inception at a single centre between 1992 and 2007 were included. Twelve autoantibodies were assayed in each patient at years 1, 3 and 5 of disease.

Variability over time and correlates of cholesterol and blood pressure in systemic lupus erythematosus: a longitudinal cohort study.

Introduction: Total cholesterol (TC) and blood pressure (BP) are likely to take a dynamic course over time in patients with systemic lupus erythematosus (SLE). This would have important implications in terms of using single-point-in-time measurements of these variables to assess coronary artery disease (CAD) risk. The objective of this study was to describe and quantify variability over time of TC and BP among patients with SLE and to determine their correlates.

The effect of lupus nephritis on pregnancy outcome and fetal and maternal complications.

Objective: To evaluate the effect of lupus nephritis on pregnancy with respect to fetal outcome, maternal complications, and lupus activity.

Methods: All pregnancies seen between 1970 and 2003 in the Lupus Clinic were evaluated for the 3 outcomes. Renal disease was defined as the presence of nephrotic syndrome, dialysis, renal transplant, serum creatinine > 120 mmol/l, proteinuria, sterile hematuria and pyuria, or the presence of casts.

SLEDAI-2K for a 30-day window.

The aim of our study was to determine whether the SLEDAI-2K calculated using a timeframe of 30 days prior to a visit for clinical and laboratory variables was equivalent to the prescribed 10-day period. One hundred forty nine consecutive lupus patients seen over 9 weeks at the University of Toronto Lupus Clinic enrolled. The SLEDAI-2K score was completed twice, for a 10- and 30-day window.

Vitamin D insufficiency in a large female SLE cohort.

The objective of this study was to determine the vitamin D status and its relationship with disease and therapy features and with bone mineral density in women with systemic lupus erythematosus. Non-pregnant systemic lupus erythematosus women with dual-energy X-ray absorptiometry and vitamin D measurements performed between May 1 2005 and August 31 2006 were studied. In each patient, the lowest T-score of the first dual-energy X-ray absorptiometry scan during the study period was used.

Risk factors for development of coronary artery disease in women with systemic lupus erythematosus.

Objective: To ascertain coronary artery disease (CAD) outcomes and predictive factors in a prospective study of patients with systemic lupus erythematosus (SLE) and matched healthy controls.

Methods: SLE patients and non-SLE age-matched controls without a history of CAD were recruited into a prospective study between 1997 and 1999. CAD events were assessed at clinic visit for SLE patients and through telephone interview and chart review for controls.

Variability and correlates of high sensitivity C-reactive protein in systemic lupus erythematosus.

In the general population, high-sensitivity C-reactive protein (hsCRP), a marker of inflammation, is relatively stable over time and independently predicts cardiovascular events. Systemic lupus erythematosus (SLE), a chronic inflammatory disease, is strongly associated with coronary artery disease (CAD). The objective of this study was to determine the variability and correlates of hsCRP in patients with SLE.

Frequency and determinants of flare and persistently active disease in systemic lupus erythematosus.

Objective: Selection of flare as the primary outcome variable in systemic lupus erythematosus (SLE) clinical trials fails to capture patients with persistently active disease (PAD). We sought to elucidate the frequency and determinants of flare and PAD.

Methods: Prospectively collected data from the Toronto Lupus Cohort were used to determine the incidence of flare and PAD in 2004 and 2005.

Epidemiology of atherosclerosis in systemic lupus erythematosus.

Patients with systemic lupus erythematosus (SLE) have a significantly increased risk of atherosclerotic coronary events. Traditional risk factors, such as hypertension and hypercholesterolemia, only partly account for the increased risk of coronary disease in SLE. Other important risk factors include disease and treatment-related factors.

Hormone replacement therapy in women with systemic lupus erythematosus and risk of cardiovascular disease.

We sought to determine the impact of hormone replacement therapy (HRT) on the occurrence of coronary artery disease (CAD) in women with systemic lupus erythematosus (SLE). Women in the University of Toronto lupus database who had taken HRT with no history of CAD were compared with all post-menopausal female patients with no history of HRT or CAD. Chi-squared and t-tests were used to compare the risk factors of CAD and Kaplan-Meier curve, log rank test and proportional hazard model with time-dependent covariates were used to compare the time from entry into the clinic to occurrence of CAD.