Martha L. Sanchez

Development and initial validation of a self-assessed lupus organ damage instrument.

The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) is a validated instrument for assessing organ damage in systemic lupus erythematosus (SLE). Trained physicians must complete it, thus limiting utility where this is impossible.

Systemic lupus erythematosus in a multiethnic US cohort (LUMINA) XXXI: factors associated with patients being lost to follow-up:

The objective of this study was to determine the frequency of loss to follow-up and the factors predictive of its occurrence in a systemic lupus erythematosus (SLE) multiethnic cohort. We studied SLE patients from the LUMINA cohort (Hispanics from Texas and from the Island of Puerto Rico, African-Americans and Caucasians). Loss to follow-up was defined as subjects who failed to attend two or more of the latest consecutive yearly study visits. The relationship between baseline features and loss to follow-up was examined by univariable and multivariable Cox regression analyses with loss to follow-up as the dependent variable. The retention rate in the cohort was estimated by the Kaplan-Meier method. Five-hundred and fifty-four patients with a mean (SD) follow-up of 3.4 (2.9) years were studied. One-hundred and fifty-eight (29%) met the definition of lost to follow-up. The cumulative loss to follow-up rate at five years was 36%. The cumulative loss to follow-up rate at five years was higher for the African-Americans. Patients lost to follow-up tended to be younger and more likely to have poor social support and higher levels of helplessness. They also tended to have more renal involvement and more active disease as per the Systemic Lupus Activity Measure-Revised. Disease activity (hazard ratio = 1.04, 95% confidence interval 1.01-1.07, P = 0.02) was the only variable independently contributing to loss to follow-up. Our data suggest that in longitudinal SLE studies, loss to follow-up does not occur at random and it differs between ethnic groups and is also particularly higher among patients with more active disease. Pro-active measures may need to be applied to decrease the probability of patients ‘at risk’ of becoming lost to follow-up and to preserve the integrity of the cohort.

Can the weighted criteria improve our ability to capture a larger number of lupus patients into observational and interventional studies? A comparison with the American College of Rheumatology criteria.

The objective of this study was to determine if the modified weighted criteria have better psychometric properties than the ACR criteria for the classification of patients with systemic lupus erythematosus (SLE). A computerized list of all patients with the diagnosis of SLE (ICD9 code 710.0) attending an outpatient rheumatology clinic was generated and their medical records reviewed. The attending rheumatologists validated the diagnosis of SLE; this assessment was used as the gold standard to compute the sensitivity, specificity and accuracy of both the American College of Rheumatology (ACR) and the modified weighted criteria. A total of 363 patients were identified and included in the study. Ninety percent were women; the mean age was 44.0 (14.4) years, and 51% were Caucasians. The modified weighted criteria had a sensitivity of 90.3% and specificity of 60.4%. The ACR criteria had a sensitivity of 86.5% and specificity of 71.9%. Both methods had comparable positive and negativepredictivevalues as well as similar overall accuracy. The modified weighted criteria allow the identification of more lupus patients for clinical or interventional studies; some of these patients, however, may not have SLE according to experienced rheumatologists.

Characterisation of two human dendritic cell-lines that express CD1a, take-up, process and present soluble antigens and induce MLR

Dendritic cells (DC) are bone marrow derived cells present in diverse tissues and organs including the skin, mucosae and blood. DC have a capital role in the afferent pathway of the immune response because of its role in up-take, processing and presenting antigens to immune cells. Human DC are usually identified by the expression of surface CD1a and HLA-DR. Despite the significant recent developments for in vitro generation of DC derived from blood by using cytokines like GM-CSF and IL-4, the studies on DC and specially on human Langerhans cells (LC) have been hampered by the laborious isolation procedure and the small yield of cells obtained by the various methods of isolation used so far. Therefore, a priority has been a search for monoclonal dendritic cell-lines with LC characteristics in order to facilitate the research in this area. The present study reports on the generation of two stable, self-replicant, adherent, dendritic, CD1a+, HLA-DR , CD45RO , CD23/FcERII+ cell-lines that up-take and process soluble antigens but also inducing MLR and antigen-dependent T-cell response.