Faculty Bibliography

Objective: To estimate the early prevalence of various electrocardiographic (ECG) abnormalities in patients with SLE and to evaluate possible associations between repolarization changes (increased corrected QT, QTc, and QT dispersion, QTd) and clinical and laboratory variables, including the anti-Ro/SSA level and specificity (52 or 60KDa). Methods: We studied adult SLE patients from 19 centers participating in the Systemic Lupus International Collaborating Clinics (SLICC) Inception Registry. Demographics, disease activity (SLEDAI-2K), disease damage (SLICC/ACR DI), and laboratory data from the baseline or first follow-up visit were assessed. Multivariate logistic and linear regression models were used to asses for any cross-sectional associations between anti-Ro/SSA and ECG repolarization abnormalities. Results: For the 779 patients included, mean age (SD) was 35.6 years (13.8), 88.4% were women, and mean disease duration was 10.5 months (14.4). Mean SLEDAI-2K was 5.4 (5.6) and mean SLICC/ACR DI was 0.5 (1.0). ECG abnormalities were frequent and included non-specific ST-T changes (30.9%), possible left ventricular hypertrophy (5.4%) and supraventricular arrhythmias (1.3%). A QTc >/= 440ms was found in 15.3%, while QTc >/= 460ms was found in 5.3%. Mean (SD) QTd was 34.2ms (14.7) and QTd >/= 40ms was frequent (38.1%). Neither the specificity, nor the level of anti-Ro/SSA was associated with QTc duration or QTd, although confidence intervals were wide. Total DI was significantly associated with a QTc interval exceeding 440 ms (OR 1.38 95% CI 1.06, 1.79). Conclusion: A substantial proportion of recent-onset SLE patients exhibit repolarization abnormalities although severe abnormalities were rare. (c) 2014 American College of Rheumatology.

This review describes eight 'great ideas' regarding bench-to-bedside considerations in systemic lupus erythematosus (SLE) presented at the second international LUPUS meeting in Quebec, September 2014. The topics included: correcting the impaired clearance of apoptotic fragments; optimisation of clinical trial design: the PERFECT (Pre Evaluation Reducing Frighteningly Elevated Coverable Targets) study; lipidomics and metabolomics in SLE; importance of the inflammasome; identification and treatment of asymptomatic autoimmunity: prevention of SLE; combining low doses of hydroxychloroquine and quinacrine for long-term maintenance therapy of SLE; reducing emergency room visits and the critical relevance of the autoantigen.

OBJECTIVE:Current disease activity measures for systemic lupus erythematosus (SLE) are difficult to score or interpret and problematic for use in clinical practice. Lupus Foundation of America (LFA)-Rapid Evaluation of Activity in Lupus (REAL) is a pilot application composed of anchored visual analogue scores (0-100 mm each) for each organ affected by lupus. This study evaluated the use of LFA-REAL in capturing SLE disease activity. METHODS:In a preliminary test of LFA-REAL, this simplified, organ-based system was compared with the most widely used outcome measures in clinical trials, the British Isles Lupus Assessment Group 2004 Index (BILAG), the SLE Disease Activity Index (SLEDAI) and the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) SLEDAI Physician's Global Assessment (SS-PGA). The level of agreement was analysed using Spearman rank correlations. RESULTS:91 patients with SLE with mild to severe disease activity were evaluated, their median SLEDAI score was 4.0 (range 0-28) and BILAG score 8.0 (0-32). The median SS-PGA was 38 mm (4-92) versus the total REAL 50 mm (0-268), which expands in range by additive organ scores. Thirty-three patients had moderate to severe disease activity (≥1.5 on SS-PGA landmarks). The median SS-PGA score of this group was 66 mm (50-92) versus median REAL score of 100 mm (59-268), confirming ability to detect a wider distribution of scores at higher disease activity. Total REAL correlated with SLEDAI, BILAG and SS-PGA (correlation coefficient=0.816, 0.933 and 0.903, respectively; p<0.001 for all). Individual LFA-REAL organ scores for musculoskeletal and mucocutaneous also correlated with corresponding BILAG domain scores (correlation coefficient=0.925 and 0.934, p<0.001). CONCLUSIONS:In this preliminary exercise, there were strong correlations between LFA-REAL and validated lupus disease activity indices. Further development may be valuable for consistent scoring in clinical trials, grading optimal assessment of change in disease activity and reliable monitoring of patients in practice.