IntroductionMultiple factors, including proteinuria, antiphospholipid syndrome, thrombocytopenia and hypertension, are predictive of pregnancy loss in systemic lupus erythematosus (SLE). In the PROMISSE study of predictors of pregnancy loss, only a battery of lupus anticoagulant tests was predictive of a composite of adverse pregnancy outcomes. We examined the predictive value of one baseline lupus anticoagulant test (dilute Russell viper venom time) with pregnancy loss in women with SLE.MethodsFrom the Hopkins Lupus Cohort, there were 202 pregnancies from 175 different women after excluding twin pregnancies and pregnancies for which we did not have a first trimester assessment of lupus anticoagulant. We determined the percentage of women who had a pregnancy loss in groups defined by potential risk factors. The lupus anticoagulant was determined by dilute Russell viper venom time with appropriate mixing and confirmatory testing. Generalised estimating equations were used to calculate p values, accounting for repeated pregnancies in the same woman.ResultsThe age at pregnancy was <20 years (2%), 20–29 (53%), 30–39 (41%) and >40 (3%). 55% were Caucasian and 34% African-American. Among those with lupus anticoagulant during the first trimester, 6/16 (38%) experienced a pregnancy loss compared with only 16/186 (9%) of other pregnancies (p=0.003). In addition, those with low complement or higher disease activity had a higher rate of pregnancy loss than those without (p=0.049 and 0.005, respectively). In contrast, there was no association between elevated anticardiolipin in the first trimester and pregnancy loss.ConclusionsThe strongest predictor of pregnancy loss in SLE in the first trimester is the lupus anticoagulant. In addition, moderate disease activity by the physician global assessment and low complement measured in the first trimester were predictive of pregnancy loss. These data suggest that treatment of the lupus anticoagulant could be considered, even in the absence of history of pregnancy loss.

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Abstract BACKGROUND Arthritis is a public health concern because of the high prevalence reported in various settings as well as its impact on health-related quality of life (HRQOL). The main objective of this study was to determine the prevalence of self-reported joint pain, arthritis and its associations with quality of life in a Trinidadian primary care population. METHODS A cross-sectional study was conducted on adult outpatients from 16 randomly selected primary care centres. An interviewer administered questionnaire was used to collect data on arthritis and HRQOL domains. Data was analysed using Statistical Package for the Social Sciences (SPSS, version 21) using Fisher’s exact, Chi-square testing, correlation and t-tests. Regression analysis was also done for predictors of HRQOL. RESULTS Of 421 subjects approached, 392 (93%) completed this survey. The average age was 46 ± 17.8 years with 60.5% of respondents being female and 75% being of either East Indian or African descent. Joint pain in the past 6 months, reported by 57.9% of participants, was associated with female gender (P = 0.016), East Indian descent (P = 0.001), unemployment (P < 0.001) and primary school education level (P < 0.001). There was significant (P < 0.005) upset in all domains of quality of life in those with joint pain. Severity and duration of joint pain was also positively correlated with worse HRQOL scores (P < 0.05). CONCLUSION This study highlighted the high prevalence of self-reported joint pain in Trinidad and its negative effects on HRQOL. There is an urgent need to address arthritis and the resulting morbidity in this setting.