An inception cohort of patients with systemic lupus erythematosus from 14 European centres was followed for up to 5 years in order to describe the current early disease course. At inclusion patients (n ¼ 200, 89% female, mean age 35 years, 97% Caucasian, mean SLEDAI 12.2) fulfilled a mean of 6.5 ACR classification criteria. The most prevalent criteria were antinuclear Ab presence (97%) followed by anti-dsDNA Ab (74%), arthritis (69%), leukocytopenia (54%) and malar rash (53%), antiphospholipid Ab (48%) and anti-synovial membrane Ab (21.6%). Clinical signs of lupus nephritis (LN) were present in 39% with biopsy-confirmed LN seen in 25%. Frequent additional findings were hypocomplementaemia (54%), anti-SSA Ab (49%), alopecia (26%) and Raynaud's phenomenon (31%). There were few regional differences in disease presentation and management. One and 5-year survival rates were 99% and 97% respectively. During the mean follow-up of 4.1 years 25% entered a state of early disease quiescence by global physician assessment, but the overall risk of subsequent flare was 60%. Maximum SLEDAI scores decreased over time, but 45% of patients accrued damage (SDI !1) for which baseline presence of proteinuria and persistent disease activity were independent predictors. The results indicate minor differences in SLE presentation and treatment within various regions of Europe and a high diagnostic reliance on anti-dsDNA Ab. Despite early reductions in disease activity and improved mortality, the risk for disease flare and damage development is, however, still substantial, especially in patients not entering an early remission. Lupus (2010) 19, 949-956.

We reassessed renal biopsy specimens from 116 patients with systemic lupus erythematosus and clinical manifestations of lupus nephritis to determine the contributions of the World Health Organization classification system, the activity and chronicity indexes of the National Institutes of Health scoring system, and various clinical parameters at the time of biopsy to predicting disease outcome. Multivariate analysis showed that only a chronicity index >3 was predictive for decreased renal survival, while age >31 years at biopsy and a chronicity index >3 were associated with decreased patient survival. Clinical tests of renal function were not reliable in discriminating between active lesions and chronic renal damage.Despite recent impressive improvements in patient survival compared with the presteroid era, renal disease secondary to systemic lupus erythematosus (SLE) is still associated with high morbidity and mortality rates (14). At present, uncertainty still exists about the prognostic value of various parameters in lupus nephritis, but recent cumulative evidence indicates that the presence of the following parameters at biopsy is associated with increased risk for renal failure: young age (<23 years), increased serum creatinine levels, diffuse proliferative lesions (World Health Organization [WHO] class IV), and a high chronicity index on renal histologic analysis (4-10).In this study, we analyzed 116 SLE patients with clinical evidence of lupus nephritis to determine the contribution of various factors to their prognosis and, in particular, the merits of evaluating renal histology in these patients. We also examined possible correlations between clinical and histologic data at the time of renal biopsy to see if the biopsy findings could have been predicted by simple clinical data determined at the time of biopsy. PATIENTS AND METHODSPatients. In order to obtain an adequate study population, all 8 university hospitals and major teaching hospitals treating patients with SLE in The Netherlands were asked to cooperate in this study. Nearly 20% of those contacted declined cooperation for various reasons (disagreement with study protocol, insufficient time). The remaining 80% of clinicians agreed to provide data and renal biopsy specimens from all their patients with lupus nephritis who had undergone biopsy. We obtained 152 renal biopsies, 10 of which were repeat biopsies and were therefore not included in our analysis; another 26 samples had to be excluded for various reasons (14 due to insufficient material [less than 6 glomeruli], 9 because the diagnosis of SLE did not meet the American Rheumatism Association [ A M ] criteria [ 11.121, and 3 because postbiopsy followup, before an end-point of either death or renal dialysis was reached. was

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Patients with systemic lupus erythematosus and end-stage renal failure are excellent candidates for renal transplantation; disease activity after transplantation is sporadic and low, and the recurrence of lupus nephritis is rare.