Myocardial perfusion imaging in assessing risk of coronary events in patients with systemic lupus erythematosus.

Objective: Classic risk factors do not fully account for the increased risk of coronary artery disease (CAD) in systemic lupus erythematosus (SLE), making identification of the subset of patients at risk challenging. In this prospective cohort study we investigated whether myocardial perfusion defects in SLE are predictive of CAD events, independently of traditional Framingham risk factors.

Methods: We performed myocardial perfusion imaging in 122 women with SLE who did not have a history of CAD.

The SLICC inception cohort for atherosclerosis.

The Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) is a group of rheumatologists and methodologists from 27 international centers who have a particular interest and expertise in systemic lupus erythematosus. Initially, its efforts focused on development and validation of disease activity and damage indices. In 2000, the SLICC Registry for Atherosclerosis was established to determine the incidence, prevalence, nature, and risk factors of atherosclerotic coronary artery disease in systemic lupus erythematosus.

Neurocognitive abnormalities in offspring of mothers with systemic lupus erythematosus.

Offspring of systemic lupus erythematosus (SLE) patients delivered during follow-up in the lupus clinic from 1973 to 1998 were assessed for SLE and by age-appropriate neurocognitive tests. Nine domains were evaluated. Controls, matched for age, sex, race and socio-economic status, underwent the same neurodevelopmental/neuropsychological evaluation.

Quality of life over time in patients with systemic lupus erythematosus.

Objective: To determine whether quality of life in patients with systemic lupus erythematosus (SLE) measured by the Short Form 36 (SF-36) changes over time and which patient- and disease-related factors influence such change.

Methods: SLE patients who had > or =6 SF-36 evaluations during followup were identified from a database. Outcomes were slopes of scores of the 8 SF-36 domains as well as the physical and mental component scores.

Association of a gene expression profile from whole blood with disease activity in systemic lupus erythaematosus.

Objective: To determine whether peripheral blood gene expression of patients with systemic lupus erythaematosus (SLE) correlates with disease activity measured using the SLE Disease Activity Index 2000 (SLEDAI-2K).

Methods: RNA was isolated from peripheral blood of 269 patients with SLE and profiled on a custom microarray. Hierarchical clustering and a heat map were used to categorise samples into major clusters based on gene expression pattern.

Clinical manifestations and coronary artery disease risk factors at diagnosis of systemic lupus erythematosus: data from an international inception cohort.

Systemic Lupus International Collaborating Clinics (SLICC) comprises 27 centres from 11 countries. An inception cohort of 918 SLE patients has been assembled according to a standardized protocol between 2000 and 2006. Clinical features, classic coronary artery disease (CAD) risk factors, as well as other potential risk factors were collected.

Outcomes in patients with active lupus nephritis requiring immunosuppressives who never received cyclophosphamide.

Objective: To assess outcomes in patients with lupus nephritis treated with immunosuppressives compared to those treated with cyclophosphamide in a cohort study and in a matched cohort study.

Methods: Patients with active renal disease treated with immunosuppressive/cytotoxic medications were selected from the University of Toronto Lupus Clinic database. Five outcomes were evaluated: all-cause mortality, renal failure, reversal of active renal disease, relapse of active renal disease, and toxicity.

The role of non-corticosteroid related factors in osteonecrosis (ON) in systemic lupus erythematosus: a nested case-control study of inception patients.

Several factors have been associated with the development of osteonecrosis (ON) in SLE but corticosteroid (CS) therapy has been the most consistent association. We sought to determine factors that predisposed to, or protected from, the development of ON in lupus patients when cumulative oral corticosteroid doses were matched between cases and controls, thereby removing presence of corticosteroid therapy and cumulative dose as risk factors. A nested case-control study of an inception cohort of SLE patients was used to determine the clinical, laboratory and therapeutic differences between patients who developed their first ON event and patients who did not develop ON, having matched these groups for their cumulative oral corticosteroid doses.

Fatigue in systemic lupus erythematosus: contributions of disordered sleep, sleepiness, and depression.

Objective: To clarify the role of sleep disorders, sleepiness, and depression in patients with systemic lupus erythematosus (SLE) who complain of disabling tiredness.

Methods: Patients with SLE (31 women, 4 men) with disabling tiredness were evaluated with the Epworth Sleepiness Scale (ESS) and overnight polysomnography, followed by daytime multiple sleep latency tests (MSLT) and the Beck Depression Inventory (BDI). Their polysomnography was compared with 17 healthy, asymptomatic controls.

Atherosclerotic vascular events in a single large lupus cohort: prevalence and risk factors.

Objective: To determine prevalence and type of atherosclerotic vascular events (AVE) occurring after entry to the University of Toronto Lupus Clinic; and to compare risk factors in patients with systemic lupus erythematosus (SLE) with AVE to matched SLE controls without AVE.

Methods: Patients with SLE attending the University of Toronto Lupus Clinic who did not have AVE prior to clinic entry were included. Patients have been followed at 2-6 months since 1970 according to a standard protocol.

The effect of menopause on disease activity in systemic lupus erythematosus.

Objective: To determine the effect of menopause on disease activity and course of systemic lupus erythematosus (SLE).

Methods: Patients were identified from the University of Toronto lupus clinic database. Menopause was diagnosed on the basis of 12 months of amenorrhea.

Anti-dsDNA and anti-Sm antibodies do not predict damage in systemic lupus erythematosus.

We aimed to determine whether anti-dsDNA and anti-Sm antibodies predict damage in systemic lupus erythematosus (SLE). Five-hundred inception patients from the University of Toronto Lupus Clinic were studied. Predictors assessed for the entire study period were: (1) raised anti-dsDNA on two consecutive occasions; (2) anti-dsDNA levels (normal, mildly or highly elevated); (3) presence of antiSm on any occasion.

Prolonged remission in systemic lupus erythematosus.

Objective: To determine the frequency of prolonged remission in systemic lupus erythematosus (SLE) using strict criteria for remission and to define disease characteristics and prognosis of patients achieving this state. To also determine the frequency of remission utilizing less restrictive definitions, such as allowing shorter period of disease quiescence, persistence of serological activity, or treatment in the absence of clinical disease.

Methods: Patients registered in the Lupus Clinic database between 1970 and 1997 with visits no more than 18 months apart were identified.

Premature atherosclerosis in systemic lupus erythematosus.

Significant advances have been made in defining the spectrum of clinical manifestations and the prognosis of systemic lupus erythematosus (SLE). With the use of corticosteroids and other immunosuppressive agents as well as better management of complications such as infection, there has been a dramatic improvement in the short-term prognosis of patients who have SLE from less than 50% survival at 5 years to 93% at 5 years and 85% and 10 years. However, many patients who survive early complications of organ failure and sepsis later develop premature coronary artery disease (CAD).

Pulmonary hypertension in systemic lupus.

Pulmonary arterial hypertension (PAH) has devastating consequences in the rheumatic diseases; however, the prevalence in lupus is not well delineated. We searched the University of Toronto lupus database to ascertain the first echocardiogram ordered at their physician's discretion between 1995 and 2002. We reviewed the echocardiogram reports for right ventricular systolic pressure (RVSP), valvular disease, and atrial and ventricular function.

Osteoporosis in systemic lupus erythematosus: factors associated with referral for bone mineral density studies, prevalence of osteoporosis and factors associated with reduced bone density.

The purpose of this study was to evaluate the clinical characteristics of women with systemic lupus erythematosus (SLE) sent for a dual energy X-ray absorptiometry (DEXA) study, and to analyse the factors associated with a lower bone mineral density in these patients. Women with SLE who had a DEXA done between 1 January 1995 and 31 December 2000 were compared with those who did not have DEXA scans performed. SLE patients with osteoporosis (OP) were compared with those with a normal bone density.

Risk factors for coronary heart disease in women with systemic lupus erythematosus: the Toronto Risk Factor Study.

Objective: Because women with systemic lupus erythematosus (SLE) are 5-8 times more likely to develop coronary heart disease (CHD) than are women in the general population, we assessed the prevalence of classic risk factors for CHD in women with SLE.

Methods: Consecutive female patients with SLE who were without evidence of CHD and were attending a large lupus clinic in Toronto were studied. The control population was recruited from among age-matched subjects attending a family practice unit for an annual physical examination.

Summarizing disease features over time: I. Adjusted mean SLEDAI derivation and application to an index of disease activity in lupus.

Objective: To develop a measurement of lupus disease activity over time.

Methods: We studied patients from the University of Toronto Lupus Clinic with "regular" followup, defined as having been in the clinic for at least 3 visits and never having been away from the clinic for a period exceeding 18 consecutive months. For each visit, disease activity was evaluated with the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K).

Clinically active serologically quiescent systemic lupus erythematosus.

Objective: To identify the frequency and characteristics of clinical activity with serological quiescence (CASQ) in a large cohort of patients with systemic lupus erythematosus (SLE) followed prospectively at a single center.

Methods: Patients followed at the Lupus Clinic between 1991 and 1995 who on at least 3 consecutive visits had clinical activity in the absence of a low complement and elevated DNA binding were identified. Demographics, disease characteristics, and therapy for the CASQ periods, as well as prior and subsequent disease course until April 2002 were analyzed.

Accrual of organ damage over time in patients with systemic lupus erythematosus.

Objective: To determine the pattern of accumulation of damage in an inception cohort of patients with systemic lupus erythematosus (SLE) followed yearly for at least 15 years, and to identify damage items that might be related to corticosteroid therapy.

Methods: An inception cohort was identified from among patients with SLE followed prospectively in the University of Toronto Lupus Clinic. Only patients who had at least yearly evaluations and were followed for at least 15 years were included.

Single photon emission computed tomography dual isotope myocardial perfusion imaging in women with systemic lupus erythematosus. II. Predictive factors for perfusion abnormalities.

Objective: We have reported that 40% of patients with systemic lupus erythematosus (SLE) had abnormal myocardial perfusion studies. Here we investigated risk factors for abnormal myocardial perfusion in a cohort of women with SLE without history of coronary artery disease.

Methods: Consecutive women with SLE followed at a large lupus clinic underwent single photon emission computed tomography dual isotope myocardial perfusion imaging (DIMPI) following pharmacological stress using dipyridamole.

Role of specialty care in the management of patients with systemic lupus erythematosus.

Objective: To determine the role of rheumatologists in the management of systemic lupus erythematosus (SLE).

Methods: The lupus clinic database was searched for patients with 3 consecutive visits (every 3-4 months) of which the first 2 visits recorded a SLE Disease Activity Index (SLEDAI) of 0. The clinic notes were examined by a physician blinded to the SLEDAI score at the third visit.

The nature and outcome of infection in systemic lupus erythematosus.

Infection remains a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). To describe the nature and outcomes of infection and determine their associated risk factors in patients with SLE, we performed a nested case-control study at the University of Toronto Lupus Clinic, with prospective follow-up according to a standard protocol since 1970. Cases were SLE patients seen between January 1987 and January 1992 who had documented infections and controls were patients without infection from the same cohort matched for age, gender and time of visit.

Systemic lupus erythematosus disease activity index 2000.

Objective: To describe the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), a modification of SLEDAI to reflect persistent, active disease in those descriptors that had previously only considered new or recurrent occurrences, and to validate SLEDAI-2K against the original SLEDAI as a predictor for mortality and as a measure of global disease activity in the clinic.

Methods: All visits in our cohort of 960 patients were used to correlate SLEDAI-2K against the original SLEDAI, and the whole cohort was used to validate SLEDAI-2K as a predictor of mortality. A subgroup of 212 patients with SLE followed at the Lupus Clinic who had 5 regular visits, 3-6 months apart, in 1991-93 was also included.

Outcomes of symptomatic osteonecrosis in 95 patients with systemic lupus erythematosus.

Objective: To describe the frequency and type of symptomatic osteonecrosis (ON) in a large cohort of patients with systemic lupus erythematosus (SLE) followed in a single center and to describe the outcome in terms of mortality and disability compared to SLE patients without ON.

Methods: Patients with ON were identified from the University of Toronto Lupus Clinic Database. The diagnosis of ON was confirmed by radiographs, bone scans, tomograms, or magnetic resonance images.