Objective. To determine the value of measurement of serum soluble tumor necrosis factor receptor (sTNFR), compared with established parameters such as anti-double-stranded DNA, in monitoring systemic lupus erythematosus (SLE) disease activity, and to determine whether serum sTNFR are bioactive and can effectively inhibit TNF bioactivity .Methods. Fifty-three consecutive ambulatory or hospitalized SLE patients and 140 consecutive healthy subjects were enrolled in a prospective cohort study. Serum levels of sTNFR were measured by a unique 2-sided capture enzyme-linked immunosorbent assay

Systemic lupus erythematosus-associated irreversible organ/system damage was previously associated with various clinical and demographic features. We analysed the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI) in a cohort of 151 Israeli patients followed for a mean (+/- s.d.) period of 45.7 +/- 37.4 months. Mean score of SLICC/ACR DI at the first and last encounters were 0.17 +/- 64 and 1.64 +/- 2.1, respectively (P < 0.0001). Multiple logistic regression analyses disclosed a statistically significant positive correlation with corticosteroid and cyclophosphamide therapy. Hydroxychloroquine therapy was significantly associated with lower SLICC/ACR DI. Although the size of our study group did not allow us to find specific organs/systems which were associated with the protective effect of hydroxychloroquine, we suggest this is due to the antiatherogenic effects attributed to antimalarial therapy in SLE.

Significant fatigue was observed in 63/83 (76%) SLE patients. Patients with fatigue had significantly lower lymphocyte counts (1090 +/- 60 vs 1675 +/- 205 cells/mm3 P = 0.003), and higher ratings for headache, nervousness and musculoskeletal symptoms and signs. These disease parameters also correlate significantly with the magnitude of fatigue. Fatigue correlated with disease activity index (r = 0.49 P < 0.001).

Lymphadenopathy (LAP) is a frequent sign in systemic lupus erythematosus (SLE). Yet, data concerning its relation to the various disease manifestations are scarce or absent. LAP was present in 23/90 (26%) SLE patients. Patients with LAP had significantly more constitutional symptoms of fatigue, fever and weight loss, more cutaneous symptoms and signs, a higher rate of hepatomegaly and splenomegaly, increased anti-dsDNA antibodies and decreased complement levels. Disease activity index was higher among patients with LAP, as was the intake of steroids and antimalaria medications. There was no difference in renal or central nervous system (CNS) involvement between patients with LAP and those without LAP.