The underlying mechanisms for the subsets of self-limiting, intermittent or chronic and deforming arthritis in systemic lupus erythematosus (SLE) are not well understood. We performed a cross-sectional analysis of pro-inflammatory cytokines (IL-1β, IL-2, IL-6, IL-8 and TNF-α) and joint status in 47 SLE patients (79% females, age 42 years, disease duration 8.6 years). All cytokines levels were significantly elevated in SLE patients compared with controls, but only IL-2 and IL-8 levels were higher than in patients with rheumatoid arthritis. SLE patients with ongoing synovitis (19%) and joint deformities (11%) had increased erythrocyte sedimentation rate (ESR), IL-6 and anti-dsDNA Ab levels. IL-6 levels correlated with ESR, anti-dsDNA Ab and haemoglobin, but not with C-reactive protein levels. Arthritis constitutes a considerable burden of disease in SLE over time, and joint deformations are associated with longstanding disease and arthritis flare rates. IL-6 is a potential biomarker and therapeutic target in the prevention of joint damage in SLE arthritis.

While both s-BAFF and s-APRIL levels are elevated in SLE patients, they reflect different immunologic and clinical pathways. The strong association between s-APRIL and IL-17 activation supports a role for Th17 helper cells in B cell activation in SLE.

Background and aims Lupus nephritis is the most severe involvements of internal organs that may develop patients with systemic lupus erythematosus (SLE). Studying the worldwide distribution of this feature across geographic regions and ethnic groups using a big data-driven approach may help obtain a more high-definition resolution of lupus nephritis Methods We made a text-word search in Google between 8th and 15th May 2015 using SLE and 100...100000000 patients. We selected the cohorts in which the frequency of renal involvement was detailed, and we analysed the influence on this frequency of the characteristics of the cohorts. Results Of the 63 263 patients included, renal involvement was reported in 24 790 patients(38%).The rate of renal involvement was influenced by the predominant ethnicity:it was lower in cohorts in white patients in comparison with a multiethnic origin(p=0.008).The mean age at SLE diagnosis was higher in cohorts in which the mean age was <40 years (p=0.019).The rate of renal involvement was higher in cohorts with a frequency of positive antiDNA antibodies higher than 75%(p=0.031),cohorts with a frequency of positive antiSm antibodies higher than 25%(p=0.046), cohorts with a frequency of positive antiRNP antibodies higher than 25%(p=0.031) and cohorts with a frequency of positive antiLa/SSB antibodies higher than 15%(p=0.025). Conclusions This big data analytical approach confirm that the rate of renal involvement is influenced by ethnicity, the mean age at SLE diagnosis and the frequency of positive autoantibodies.The higher rates of renal involvement being found in US and Asian studies,with the youngest patients at the time of SLE diagnosis and highest rates of immunopositive patients.

BackgroundHypocomplementemia (HC) represents a significant clinical finding in Systemic Lupus Erythematosus (SLE) as it suggests complement activation by immune-complexes, which can initiate inflammation. As disease activity contributes to damage accrual in SLE patients, we investigated the role of HC as a predictor of subsequent organ damage.ObjectivesInvestigate the relationship between HC, disease flares and organ damage accrual in SLE patients.MethodsLongitudinal cohort study of 102 SLE patients with HC defined as a C3 and/or C4 levels below cut-off during median follow-up of 13.8 years (IQR 7.0, 23.1). Disease activity was scored by time averaged SLEDAI-2K without the serological components (cWAS), flares by SELENA-SLEDAI and damage accrual by SLICC-DI. Analysis included comparisons between normocomplementemic (NC) and hypocomplementemic (HC) patients, and multivariate logistic and Cox regression modelling determined the predictive value of HC on organ damage.ResultsHC occurred in 2/3 of patients overall and was more often due to low C3 (97%) than low C4 (54%). HC patients had a higher prevalence of anti-dsDNA Ab (72% vs 36%, p<0.01) and aPL (74% vs 40%, p<0.01), but HC concurred with anti-dsDNA presence in only 36% of cases. HC patients had higher maximum cSLEDAI scores, but the time adjusted cWAS scores (1.9 vs 1.2, p=0.9) and the frequency and risk of overall damage accrual (SDI>0, n=60) associated with HC was similar as for NC patients (OR 1.08, p>0.20).ConclusionsLow complement levels occur in 2/3 of SLE patients but have negligible impact on time averaged disease activity and damage accrual in SLE. Discrepancies between low C3, low C4 and anti-dsDNA Ab occurrence indicate that in SLE alternative complement activation occurs frequently and requires further translational study.AcknowledgementsThe Rheumatology Group of UWA (JN) was supported by an unrestricted grant from the Arthritis and Osteoporosis Foundation of Western Australia (AOWA). The AOWA provided WR with a PhD Scholarship in Memory of Johan Donald Stewart.Disclosure of InterestNone declared