Our results confirm using SLEDAI, that the lupus of the elderly patients is a distinct clinical subgroup with a milder course of disease.

Objective-To evaluate bone mineral density (BMD) in premenopausal patients with systemic lupus erythematosus (SLE). Methods-We measured BMD by dual energy x ray absorptiometry at lumbar vertebrae L2-4 and at the right femoral neck in 74 premenopausal white patients (mean age 30-8 years) with SLE who were receiving glucocorticoid therapy, and in a control group. Results-The mean cumulative dose of prednisone was 32*5 (SD 28) g. The mean dose at the time of absorptiometry was 13*7 (6.9) mg. BMD was significantly reduced at the spine and at the femoral neck in SLE patients when compared with the control group: L2-4 = 0*943 (0.1) g/cm2 v 1-038 (0.1) g/cm2 (p<0.001); femoral neck = 0-766 (0-09) g/cm2 v 0*864 (0.1) g/cm2 (p < 0.001). Nine patients (12-1%), but none of the control group, had a BMD less than the reference range. Conclusion-BMD in premenopausal patients with SLE was less than that in a control group and less than the reference range of values defining the presence of osteoporosis in 12X1%. We did not find a relationship between BMD and either cumulative or baseline dose of corticosteroid therapy.

SLE patients with severe initial clinical manifestations and higher SLEDAI values may achieve clinical remission.

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Objective. To measure salivary testosterone in women with systemic lupus erythematosus (SLE).Methods. We investigated concentrations of salivary testosterone in 13 women with active SLE and 47 women with inactive SLE, and in 72 healthy female controls.Results. We found a significant decrease in salivary testosterone concentrations in glucocorticoidtreated SLE patients (mean 2 SD 0.06 f 0.04 nmoled liter) but no differences in concentrations in untreated patients (0.09 f 0.03 nmolesfiiter), compared with the healthy controls (0.11 f 0.04 nmoleshiter).Conclusion. Glucocorticoid treatment appears to cause a decrease in the salivary testosterone level. Measurement of salivary testosterone is a simple way of monitoring androgen metabolism in patients with SLE.It is well known that glucocorticoid treatment reduces serum testosterone levels in men and women (1,2). However, considerable doubts remain as to whether this effect is stronger on hormone that is bound to the transport protein or on non-proteinbound hormone, the latter being responsible for the biologic effects of the hormone. Androgen metabolism abnormalities, as well as decreased serum testosterone concentrations, have been described in women with systemic lupus erythematosus (SLE) (3-5). These effects have occurred in untreated women as well as in those undergoing treatment with glucocorticoids.Saliva is considered to be an appropriate medium for measuring concentrations of various hormones, testosterone being one of the most important (6-9). There are 2 advantages associated with the use of saliva, as opposed to serum, for hormone analysis. First, the sampling procedure is noninvasive, and second, the free hormone fraction not influenced by hormonal transport proteins can be obtained more easily. In the present investigation, we studied saliva levels of testosterone in a group of female SLE patients, some of whom were being treated with glucocorticoids. PATIENTS AND METHODSTestosterone concentrations were measured in saliva samples from 60 premenopausal women with SLE that met 4 or more of the American College of Rheumatology (formerly, the American Rheumatism Association) criteria (lo), and from 72 female controls not known to have any disease. Thirteen of the patients with SLE had active disease but had not begun treatment with glucocorticoids, and 47 had quiescent disease and were receiving glucocorticoids. The glucocorticoid dosage exceeded 25 mg of prednisone every other day in 24 of the treated patients.All saliva samples were obtained at -9:OO AM. Patients deposited their saliva into tubes prepared for this purpose. The samples were centrifuged and then frozen at -80°C until use. Testosterone concentrations were determined by radioimmunoassay according to the procedure