Y. Katsumata

Anti-MDA5 antibody, ferritin and IL-18 are useful for the evaluation of response to treatment in interstitial lung disease with anti-MDA5 antibody-positive dermatomyositis

OBJECTIVEnThe aim of this study was to investigate the precise clinical characteristics and to analyse the association between the anti-MDA5 antibody (anti-MDA5ab) titre and disease status in patients with anti-MDA5ab-positive DM.nnnMETHODSnTwenty-seven patients who presented with DM and were positive for the anti-MDA5ab were enrolled. The association between the clinical manifestations and the clinical parameters, including the anti-MDA5ab, was analysed.nnnRESULTSnThe complication of rapidly progressive interstitial lung disease (RP-ILD) occurred in 20 (74%) patients. The frequencies of fatal outcome, relapse and malignancy were 33, 4 and 4%, respectively. Remarkably, a fatal outcome occurred within the first 6 months. Compared with six non-RP-ILD patients, elderly age at onset, severely involved pulmonary function and high levels of serum ferritin were present in 20 RP-ILD patients with anti-MDA5ab. Alveolar-arterial oxygen difference (AaDO(2)) ≥32u2009mmHg and ferritin ≥828u2009ng/ml at admission were poor prognostic factors in RP-ILD patients with anti-MDA5ab-positive DM. The median value of the anti-MDA5ab titre on admission was higher in patients who later died than in those who survived. The efficacy of treatment was indicated by the anti-MDA5ab, ferritin and IL-18 concentrations. The decline index of the anti-MDA5ab titre after treatment was lower in the subset of patients who died than in the subset of patients who lived. Sustained high levels of anti-MDA5ab, ferritin and IL-18 were present in the patients who died.nnnCONCLUSIONnAnti-MDA5ab titre and ferritin and IL-18 concentrations are useful for the evaluation of the response to treatment and the status of ILD in patients with anti-MAD5ab-positive DM.

NOS2 polymorphisms associated with the susceptibility to pulmonary arterial hypertension with systemic sclerosis: contribution to the transcriptional activity.

Systemic sclerosis (SSc) is a connective tissue disease characterized by tissue fibrosis. One of several complications of SSc, pulmonary arterial hypertension (PAH) can be refractory to treatment, both novel and established. In the present study we investigated the ratio of circulating nitric oxide to endothelin-1 in patients with both SSc and PAH, and determined whether polymorphisms in NOS2 (the nitric oxide synthase 2 gene) are associated with susceptibility to PAH. Endothelin-1 in plasma and nitric oxide metabolites (nitrate and nitrite) in serum were measured. The nitric oxide/endothelin-1 ratio was significantly lower in patients with both SSc and PAH than in patients with SSc only or in healthy control individuals. We confirmed the presence of two single nucleotide polymorphisms at positions -1,026 and -277 and a pentanucleotide repeat (CCTTT) at -2.5 kilobases. There were significant differences in single nucleotide polymorphisms between patients with SSc who had PAH and those who did not, and between patients with both SSc and PAH and healthy control individuals. The CCTTT repeat was significantly shorter in patients with both SSc and PAH than in patients with SSc only or in healthy control individuals. Transcriptional activity were analyzed using the luciferase reporter assay. The transcriptional activity of NOS2 was much greater in fibroblasts transfected by a vector with a long allele of the CCTTT repeat than in those transfected by a vector with a short allele. Polymorphisms in the NOS2 gene are associated with transcriptional activity of the NOS2 gene and with susceptibility to SSc-related PAH.

Association study of a polymorphism of the CTGF gene and susceptibility to systemic sclerosis in the Japanese population

Objectives: To validate the association of a single nucleotide polymorphism (SNP) of the connective tissue growth factor gene (CTGF) with susceptibility to systemic sclerosis (SSc) in the Japanese population. Methods: 395 Japanese patients with SSc, 115 patients with rheumatoid arthritis and 269 healthy Japanese volunteers were enrolled in the study. An SNP (rs6918698) at –945 bp from the start codon in the promoter region of the CTGF gene was determined by allelic discrimination with the use of a specific TaqMan probe. Results: The G allele showed a significantly higher frequency in patients with SSc than in controls (p<0.001; odds ratio 1.5; 95% confidence interval 1.2 to 1.9). In particular, the clinical subsets of SSc showed a more significant association between the G allele and diffuse cutaneous SSc (p<0.001) and the presence of interstitial lung disease (p<0.001), the presence of anti-topoisomerase I antibody (p<0.001) and anti-U1RNP antibody (pu200a=u200a0.010). Association analyses using the genotype of the SNP yielded results similar to those of analyses using the allele. Conclusions: This study confirms the association between an SNP in the CTGF gene and susceptibility to SSc, especially in the presence of diffuse cutaneous SSc, interstitial lung disease and anti-topoisomerase I antibody. The results strongly suggest that this SNP may be a powerful indicator of severe skin and lung involvement in patients with SSc.

Single nucleotide polymorphisms of CD244 gene predispose to renal and neuropsychiatric manifestations with systemic lupus erythematosus

The objective of this study was to explore the association of single nucleotide polymorphisms (SNPs) of the CD244 gene with several clinical features of systemic lupus erythematosus (SLE). Two hundred and forty-three patients with SLE and 369 healthy controls were enrolled. Two SNPs (rs6682654 and rs3766379) in the CD244 gene were determined by allelic discrimination using a specific TaqMan probe. Only SNP rs3766379 was significantly associated with susceptibility to SLE [Pxa0=xa00.009; odds ratio (OR) 1.28; 95% confidence interval (CI) 1.04–1.57]. The association was preferentially observed in subsets of SLE patients with nephritis and neuropsychiatric lupus. The frequency of the rs6682654 C allele was strongly associated with nephritis and neuropsychiatric lupus (Pxa0=xa00.00065; OR 1.99; 95% CI 1.34–2.95, and Pxa0=xa01.6xa0×xa010−7; OR 3.47; 95% CI 2.12–5.70, respectively), as was the frequency of the rs3766379 T allele (Pxa0=xa00.0014; OR 1.86; 95% CI 1.27–2.71, and Pxa0=xa02.6xa0×xa010−7; OR 3.15; 95% CI 2.00–4.96, respectively). In this study, an SNP of the CD244 gene was associated with susceptibility to SLE. There was a strikingly strong association in SLE patients with nephritis and neuropsychiatric lupus, suggesting that this genetic marker could predict involvement of those severe complications.

SAT0667 Presepsin and procalcitonin are of diagnostic value for bacterial infection in patients with connective tissue diseases

Background Recently, presepsin (soluble CD14-subtype) and procalcitonin are reported as a good diagnostic markers of bacterial infection, especially sepsis. However, their utility in patients with connective tissue diseases (CTDs) has been unknown. Objectives To assess the diagnostic value of presepsin and procalcitonin in patients with CTDs. Methods We enrolled the consecutive patients with CTDs, who checked the level of procalcitonin and/or presepsin during January to September, 2016, retrospectively. We divided two groups; the infection group and non-infectious group. Infection was diagnosed by symptoms, micro-bacterial methods and the good response to antibiotics. The data analysis were assessed using IBM SPSS statistics 22. Results Eighty-four patients with CTDs were enrolled, including 42 patients with rheumatoid arthritis (RA). The level of procalcitonin was evaluated in all patients, and the level of presepsin was in 48 patients. Thirty-six patients were classified in infection group; 38 patients in the CRP-positive non-infection group; and 10 patients in CRP-negative non-infection group. The level of presepsin was significant higher in infection group than CRP-positive non-infection group (693 +/- 577 pg/mL vs. 250 +/- 101 pg/mL, p<0.01) (Fig. 1). Among the patients with RA, the level of presepsin was significant higher in infection group than non-infection group (809 +/- 637 pg/mL vs. 233 +/- 135 pg/mL, p<0.01). AUCs of procalcitonin (0.823) and presepsin (0.821) showed similar diagnostic value. The cut-off value of presepsin and procalcitonin were 265 pg/mL and 0.16 ng/mL, respectively (sensitivity: 78.3% and 82.6%, specificity: 76.0% and 76.0%). Conclusions Procalcitonin and presepsin may be of diagnostic value for bacterial infection in patients with CTDs, especially may distinguish bactrial infection from active phase in patients with CTDs. Disclosure of Interest None declared

THU0204 Relationships between methotrexate dosages and clinical variables in patients with rheumatoid arthritis who achieved remission with methotrexate monotherapy: a study using the iorra observational cohort study

Background Considerable variability exists in the way rheumatologists prescribe methotrexate (MTX) therapy in patients with rheumatoid arthritis (RA), including the dosage [ref.1]. Start higher doses or fast dose escalation are associated with higher efficacy, but also with more toxicity. In addition, factors such as renal function, body size, and age of the patient can affect the optimal dosage of MTX. Objectives We aimed to study the relationships between MTX dosages and clinical variables in patients with RA who achieved remission with MTX monotherapy. Methods The “Institute of Rheumatology, Rheumatoid Arthritis (IORRA)” is a single-center prospective observational cohort study established at our institute in 2000. Data (physicians and patients disease assessments, laboratory data, and many other patient information) were collected from approximately 5,000 RA patients biannually. More than 99% of RA patients treated at our institute were enrolled in this cohort, and >98% of patients answered and mailed their questionnaires back to us every time. Among the RA patients who were registered in the IORRA cohort study from 2011 through 2015, 603 patients fulfilled the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean-based definition of remission in RA, at least once and used only MTX as disease-modifying antirheumatic drugs (DMARDs) including biological DMARDs for 5 years. Relationships between MTX dosages and gender, disease duration, height, body weight, body mass index, body surface area, serum creatinine (SCr), estimated glomerular filtration rate (eGFR), creatinine clearance (by Cockcroft-Gault Equation), rheumatoid factor, and anti-cyclic citrullinated peptide antibody when remission was first reached by each patient were analyzed by univariate analyses using Pearson correlation coefficient and Welchs t test. Subsequently, a multiple regression analysis was performed. Results Univariate analyses detected several candidate clinical variables associated with MTX monotherapy dosages in RA patients who achieved remission: height, body weight, body surface area, SCr, eGFR, and CCr (p =0.004, 0.050, 0.241, <0.001, <0.001, and <0.001, respectively). Subsequently, a multiple regression model developed a best-fit model with the following variables; age, height, body weight, and SCr (standardized partial regression coefficient = -0.20, 0.10, 0.07, and -0.22, respectively), while its adjusted coefficient of determination was 0.114. Conclusions There were significant relationships between MTX monotherapy dosages and age, height, body weight, and renal function in RA patients who achieved remission. However, the low coefficient of determination indicated the model accounted for limited variability with the specified variables. References Visser K and van der Heijde D. Optimal dosage and route of administration of methotrexate in rheumatoid arthritis: a systematic review of the literature. Ann Rheum Dis. 2009;68:1094. Disclosure of Interest M. Tochihara: None declared, Y. Katsumata: None declared, E. Inoue: None declared, Y. Kawaguchi: None declared, E. Tanaka Consultant for: Abbvie, Eisai Pharmaceutical, Chugai Pharmaceutical, Bristol Myers Squibb, Astellas Pharmaceutical, Pfizer, Takeda Pharmaceutical, and Ayumi Pharmaceutical, Speakers bureau: Abbvie, Eisai Pharmaceutical, Chugai Pharmaceutical, Bristol Myers Squibb, Astellas Pharmaceutical, Pfizer, Takeda Pharmaceutical, and Ayumi Pharmaceutical, A. Nakajima Consultant for: Bristol-Meyers, Mitsubishi Tanabe Pharma, Nippon Kayaku Co. Ltd., Novartis Pharma, Pfizer, Siemens Healthcare Diagnostics K.K. and Takeda Pharmaceutical Company., Speakers bureau: Bristol-Meyers, Mitsubishi Tanabe Pharma, Nippon Kayaku Co. Ltd., Novartis Pharma, Pfizer, Siemens Healthcare Diagnostics K.K. and Takeda Pharmaceutical Company., K. Ikari Grant/research support from: Astellas, UCB, Bristol-Meyers, Pfizer, Eisai, Tanabe-Mitsubishi, Chugai, AbbVie, Janssen Pharmaceutical, Otsuka, Kaken, Asahi-Kasei, Hisamitsu and Takeda., Speakers bureau: Astellas, UCB, Bristol-Meyers, Pfizer, Eisai, Tanabe-Mitsubishi, Chugai, AbbVie, Janssen Pharmaceutical, Otsuka, Kaken, Asahi-Kasei, Hisamitsu and Takeda., A. Taniguchi Grant/research support from: AbbVie, Eisai, Takeda, Tanabe-Mitsubishi, Teijin Pharma, Pfizer., Speakers bureau: AbbVie, Eisai, Takeda, Tanabe-Mitsubishi, Teijin Pharma, Pfizer., H. Yamanaka Grant/research support from: MSD, Ayumi, AbbVie, Eisai, Ono, Astellas, Daiichi-Sankyo, Taisyo-Toyama, Takeda, Tanabe-Mitsubishi, Chugai, Teijin Pharma, Torii, Nippon Shinyaku, Pfizer. UCB. Nippon Kayaku, YL biologics, Bayer and Bristol-Meyers., Consultant for: MSD, Ayumi, AbbVie, Eisai, Ono, Astellas, Daiichi-Sankyo, Taisyo-Toyama, Takeda, Tanabe-Mitsubishi, Chugai, Teijin Pharma, Torii, Nippon Shinyaku, Pfizer. UCB. Nippon Kayaku, YL biologics, Bayer and Bristol-Meyers., Speakers bureau: MSD, Ayumi, AbbVie, Eisai, Ono, Astellas, Daiichi-Sankyo, Taisyo-Toyama, Takeda, Tanabe-Mitsubishi, Chugai, Teijin Pharma, Torii, Nippon Shinyaku, Pfizer. UCB. Nippon Kayaku, YL biologics, Bayer and Bristol-Meyers.

FRI0282 Post-Treatment Short-Term Changes in Needle Electromyography among Patients with Polymyositis and Dermatomyositis and Their Clinical Usefulness: A Retrospective Study

Background There is no established single outcome measure of muscle manifestations in polymyositis (PM) and dermatomyositis (DM) although there are partially validated preliminary definitions of improvement by the International Myositis Assessment & Clinical Studies Group (IMACS). They are core set measures including Manual Muscle Testing (MMT), muscle-associated enzymes such as creatine kinase (CK), and so on. Needle electromyography (EMG) is useful in the diagnosis of PM/DM. However, the degree and time course of changes in its findings after treatment and their associations with other measures remain elusive. Objectives We aimed to study post-treatment short-term changes in needle EMG among patients with PM/DM and their clinical usefulness. Methods Patients were included in the present study when they met all these criteria: 1) fulfill the Bohan and Peter classification criteria for PM/DM; 2) were administered to our university hospital for the treatment of muscle manifestations of PM/DM from 2008 through 2015; 3) received needle EMG before and after treatment. Needle EMG was performed by a single experienced electromyographer/neurologist in all the patients. The data of findings of needle EMG, MMT, serum CK levels, and other demographic and clinical information were retrospectively collected. The following findings of needle EMG were transformed into semiquantified relative frequencies on 0–7 point scale: fibrillation potential (Fib), positive sharp wave (Pos), low-amplitude motor unit potential (MUP) (Low), short-duration MUP (Short). MMT was assessed in 10 muscles on 0–5 point scale and their sum scores with maximum of 50 were used. Treatment was determined by physician preference in each individual. Results Ultimately, 24 patients were included in the present study, and 17 and 10 patients received needle EMG at 4 and 8 weeks after treatment, respectively: 3 patients received at both 4 and 8 weeks after treatment. Fib was detected in 23 patients, and Pos, Low, and Short were detected in all the patients before treatment. Fib, Pos, Low, and Short improved in 59%, 65%, 29%, and 24% of the patients at 4 weeks, and in 90%, 90%, 100%, and 90% of the patients at 8 weeks, respectively. When assessed by Wilcoxon signed-rank tests, Fib and Pos significantly improved at 4 weeks, and all of the needle EMG findings improved at 8 weeks (p<0.05 in each comparison). Although MMT scores and CK levels also significantly improved, their improvement did not significantly agree with the improvement of needle EMG findings except for Fib and Pos and CK levels at 8 weeks. Conclusions The present study showed that electrical activity in muscle recorded at rest (Fib and Pos) and during voluntary movement (Low and Short) significantly improved at as early as 4 and 8 weeks after treatment, respectively. It is also suggested that needle EMG findings can serve as different outcome measure from MMT and CK in PM/DM. Disclosure of Interest None declared

FRI0259 A Retrospective Study: Predictive Factors for Insufficient Improvement of Muscle Weakness after Treatment among Patients with Polymyositis and Dermatomyositis

Background The severity of muscle involvement and the response to immunosuppressive drugs are highly variable among patients with polymyositis (PM) and dermatomyositis (DM). Although previous studies reported that some clinical and laboratory features were associated with a poorer prognosis, the results were not consistent through those studies. A decade ago, we reported that the height of the baseline serum creatine kinase (CK) elevation predict the course of disease among patients treated with glucocorticoids (GCs) alone. However, other groups reported conflicting results. In addition, we later changed our basic treatment strategy to combination therapy with another immunosuppressive agent to improve response and reduce the need for GCs. Objectives We aimed to identify predictive factors for insufficient improvement of muscle weakness after treatment among patients with PM/DM, focusing more recent patients than those included in our previous report. Methods Patients were included in this retrospective study when they met all these criteria: 1) fulfill the Bohan and Peter classification criteria for PM/DM; 2) were administered to our university hospital for the treatment of muscle manifestations of PM/DM from 2008 through 2015. In addition, these patients were excluded from the study: those with clinically amyopathic DM and those complicated with other overlapping systemic autoimmune diseases or cancer. Manual muscle testing (MMT) was assessed using traditional 5 point MMT scales (i.e. the Medical Research Council Scale.) The Total MMT score included 2 axial and 8 proximal muscle groups, with a maximum potential value of 50. The Total MMT score less than 48 at 6 to 8 weeks after initiation of GC treatment was defined as insufficient improvement of muscle weakness. Clinical and laboratory parameters were statistically compared between patients with sufficient and insufficient improvement of muscle weakness. Odds ratios (ORs) for insufficient improvement of muscle weakness were assessed by multiple logistic regression analysis. Results Ultimately, 45 patients, comprising 30 PM and 15 DM patients were included in the present study. Among these, 22 were positive for anti-aminoacyl-tRNA synthetase (anti-ARS) antibodies, the mean age was 55 years, and the mean CK level before treatment was 2,544 U/l. GCs (≥0.5 mg/kg/day) were administered in all the patients and another immunosuppressant were concomitantly used in 39 patients. By univariate analyses, age and CK levels before treatment were significantly higher in patients with insufficient improvement of muscle weakness than those with sufficient improvement (p<0.05). The cut off values were determined by receiver operating characteristic curve analyses as ≥65 years for age and ≥1,900 U/l for CK level. The patients with ≥65 years old, CK ≥1,900 U/l, or negative anti-ARS antibodies were more frequent in patients with insufficient improvement. By multivariate analyses, ORs (95% confidence interval) for ≥65 years old, CK ≥1,900 U/l, and negative anti-ARS antibodies were 16 (2 to 342), 22 (3 to 526), and 9 (1.3 to 104), respectively. Conclusions The present study suggested that ≥65 years old, CK ≥1,900 U/l before treatment, and negative anti-ARS antibodies were predictive factors for insufficient improvement of muscle weakness in patients with PM/DM. Disclosure of Interest None declared

THU0342 Pregnancy Outcome in Japanese Patients with Systemic Lupus Erythematosus: A Retrospective Study of 134 Pregnancies

Background Most previous studies reported less successful fetal outcome and more frequent maternal obstetric complications in systemic lupus erythematosus (SLE) pregnancy, whereas the impact of pregnancy on SLE remains controversial. On the other hand, because there have been only a few small published studies focusing the pregnancy outcome in Japanese patients with SLE, available information is currently still insufficient for Japanese women and their partners. Objectives We aimed to investigate the pregnancy outcome in Japanese patients with SLE in more than twice larger size than previous reports. Methods The questionnaires about past pregnancies were delivered to all the Japanese women with SLE seen at our university clinic in November and December 2013. All the patients met the revised ACR classification criteria for SLE. Respondents were asked to answer the questionnaires while referring to the Maternal and Child Health Handbook, which consists of records of pregnancy, delivery, child development, and healthcare, and is filled in by obstetricians, pediatricians, and public health nurses. Clinical and laboratory data were also retrospectively collected from the medical records. Integrated data were statistically analyzed and also compared to available corresponding data in general Japanese populations. Results A total of 77 patients answered about 134 pregnancies: 18, 7, and 109 pregnancies occurred before, concomitant with, and after SLE diagnosis, respectively. In cases with pregnancies after SLE diagnosis, SLE was clinically quiescent in 105 of 109 pregnancies. Of the 116 pregnancies concomitant with or after SLE diagnosis, 81 (70%) resulted in a live birth, 14 (12%) in induced abortion, 19 (16%) in spontaneous abortion, and 2 (2%) in stillbirth. Among the 81 live births, low birth weight (LBW), fetal growth restriction (FGR), and preterm birth occurred in 43 (53%), 9 (11%), and 27 (33%) pregnancies, respectively. In general Japanese populations, these incidences were reported to be 10%, 3 to13%, and 5 to 13%, respectively. Although immunosuppressants other than steroids, namely tacrolimus, cyclosporine, and azathioprine, were continued during 9 pregnancies, these incidences were not significantly different compared to those without immunosuppressants. Of the 7 live birth pregnancies before SLE diagnosis, there were no LBW, FGR, or preterm birth. Of all, there were 2 cases of neonatal lupus. Of the 116 pregnancies concomitant with or after SLE diagnosis, pregnancy-induced hypertension (PIH) occurred in 24 (21%) pregnancies, which reportedly occurred in 3 to 5% in general Japanese populations. Maternal obstetric complications (including PIH and excluding SLE flare) more frequently occurred in the pregnancies concomitant with or after SLE diagnosis than in the pregnancies before SLE diagnosis (49/116 vs. 3/18, p =0.04). Of the 109 pregnancies after SLE diagnosis, 16 (15%) pregnancies were associated with SLE flares, but their predictors were not clarified. Conclusions The present study showed that LBW, preterm birth, and maternal obstetric complications such as PIH were associated with SLE pregnancies among Japanese women. Concurrent use of tacrolimus, cyclosporine, and azathioprine during pregnancy was not associated with poor fetal outcome. SLE flares occurred in 15% of the pregnancies, but their predictors were not clarified. Disclosure of Interest None declared

THU0330 Validiity of Protein-To-Creatinine Ratio in An Untimed Urine Specimen and Estimated Glomerular Filtration Rate as Measures of Proteinuria and Renal Function in Patients with Lupus Nephritis

Background In 2006, the American College of Rheumatology (ACR) Ad Hoc Committee on Systemic Lupus Erythematosus (SLE) recommended the urinary protein level in a spot (untimed) urine specimen (determined as urinary protein-to-urinary creatinine ratio; spot P/C ratio) over a 24-hour urine protein excretion. In addition, the committee stated that renal function refers to the estimated glomerular filtration rate (GFR) and selected the MDRD study equation. However, several subsequent reports suggested that the spot P/C ratio may be inaccurate in the assessment of the degree of proteinuria in lupus nephritis (LN). In addition, there is no consensus as to which estimating equation is preferred for estimated GFR in LN. Objectives We aimed to evaluate the validity of spot P/C ratio and estimated GFR by the modified MDRD study equation as measures of proteinuria and renal function in patients with LN. Methods A total of 61 patients with active LN who were admitted to our hospital from 2010 through 2015 were included. LN was pathologically confirmed in 51 patients and renal biopsy was not performed in the other 10 patients. In addition, 22 SLE patients without active LN in whom spot P/C ratio, 24-hour urine protein excretion, estimated GFR, and 24-hour urine creatinine clearance were measured were also included. All the patients met the revised ACR classification criteria for SLE. Clinical and laboratory data were retrospectively collected from the electronic medical records and statistically analyzed. Results The spot P/C ratio and the 24-hour urine protein excretion were moderately correlated (n=64, Pearsons r =0.62). However, the Bland-Altman plot demonstrated proportional bias (progressive deviation with values). Agreement of the spot P/C ratio ≥0.5 and the 24-hour urine protein excretion ≥0.5 g was moderate (Cohens κ =0.56) whereas that of ≥0.2 was almost perfect (κ =0.83). Measured 24-hour urine creatinine excretion ranged from 220 mg to 2120 mg; the mean and median values were 860 mg and 840 mg, respectively. Among the 10 patients in whom serial data could be obtained in more than 3 times, the spot P/C ratio and the 24-hour urine protein excretion were highly correlated (r =0.87 to 0.99), except for 2 patients (r = -0.30 and 0.68, respectively). In these serial samples derived from the 8 patients, there was substantial agreement between the spot P/C ratio and the 24-hour urine protein excretion about whether increased or decreased compared to previous data (κ =0.65). The estimated GFR by the modified MDRD study equation and the body surface area (BSA) corrected 24-hour urine creatinine clearance were moderately correlated (n=81, r =0.62). However, the Bland-Altman plot demonstrated both fixed and proportional bias. Agreement of the estimated GFR and the BSA-corrected 24-hour urine creatinine clearance ≥60 (ml/min/1.73 m2) was moderate (κ =0.48). Conclusions Our results supported the validity of spot P/C ratio and estimated GFR by the modified MDRD study equation as convenient screening and monitoring measures of proteinuria and renal function in patients with LN. However, agreement between these convenient measures and measures based on 24-hour urine collection is not always good. Spot P/C ratio and estimated GFR should be used with attention to their limitation. Disclosure of Interest None declared