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To quantitatively evaluate the diagnostic accuracy of antibodies to ribosomal P proteins (anti‐P) for neuropsychiatric systemic lupus erythematosus (NPSLE) in general, for psychosis, mood disorder, or both, and for other diffuse manifestations. This international meta‐analysis combined standardized data from 1,537 lupus patients contributed by 14 research teams. Weighted estimation of sensitivity and specificity with fixed‐effects and random‐effects models, as well as summary receiver operating characteristic (SROC) curve analysis, was used to summarize test performance. The robustness of the overall estimates was examined in sensitivity analyses that included additional studies published up to November 1, 2004 in the Medline, EMBase, and Cochrane databases.Combining the data from the 14 teams, the weighted sensitivity and specificity estimates for the diagnosis of NPSLE were 26% (95% confidence interval [95% CI] 15–42%) and 80% (95% CI 74–85%), respectively. For psychosis, mood disorder, or both, the sensitivity and specificity were 27% (95% CI 14–47%) and 80% (95% CI 74–85%), respectively. For other diffuse manifestations, the sensitivity was 24% (95% CI 12–42%), and the specificity was 80% (95% CI 73–85%). The proportion of patients with anti‐P antibodies did not vary markedly across different presentations of NPSLE. Between‐study heterogeneity was substantial, but the SROC curves were consistent with the weighted estimates. In further analyses that included another 24 published studies, only the sensitivity for psychosis and/or mood disorder was slightly improved, but it was still suboptimal (42% [95% CI 30–53%]); the specificity remained essentially the same (81% [95% CI 76–85%]).Anti‐P antibody testing has limited diagnostic value for NPSLE, and it is not helpful in differentiating among various disease phenotypes. [ABSTRACT FROM AUTHOR]

In the Euro‐Lupus Nephritis Trial (ELNT), 90 patients with lupus nephritis were randomly assigned to a high‐dose intravenous cyclophosphamide (IV CYC) regimen (6 monthly pulses and 2 quarterly pulses with escalating doses) or a low‐dose IV CYC regimen (6 pulses of 500 mg given at intervals of 2 weeks), each of which was followed by azathioprine (AZA). After a median followup of 41 months, a difference in efficacy between the 2 regimens was not observed. The present analysis was undertaken to extend the followup and to identify prognostic factors. Renal function was prospectively assessed quarterly in all 90 patients except 5 who were lost to followup. Survival curves were derived using the Kaplan‐Meier method. After a median followup of 73 months, there was no significant difference in the cumulative probability of end‐stage renal disease or doubling of the serum creatinine level in patients who received the low‐dose IV CYC regimen versus those who received the high‐dose regimen. At long‐term followup, 18 patients (8 receiving low‐dose and 10 receiving high‐dose treatment) had developed permanent renal impairment and were classified as having poor long‐term renal outcome. We demonstrated by multivariate analysis that early response to therapy at 6 months (defined as a decrease in serum creatinine level and proteinuria <1 gm/24 hours) was the best predictor of good long‐term renal outcome. Long‐term followup of patients from the ELNT confirms that, in lupus nephritis, a remission‐inducing regimen of low‐dose IV CYC followed by AZA achieves clinical results comparable with those obtained with a high‐dose regimen. Early response to therapy is predictive of good long‐term renal outcome. [ABSTRACT FROM AUTHOR]

To compare haplotype distribution in HLA–B27–positive patients with ankylosing spondylitis (AS) and healthy control subjects possessing either AS-associated HLA–B27 alleles or the non–AS-associated HLA–B*2709 allele. DNA samples from 47 HLA–B27–positive patients with AS and 76 HLA–B27–positive healthy controls (19 positive and 57 negative for B*2709) living in different areas of Sardinia were collected and typed for HLA class I and class II alleles. The third exon of the B27 gene was analyzed for the presence of Asp116 or His116, which differentiates B*2709 from the other two B27 subtypes (B*2705 and B*2702) that are mostly found in Sardinia. The parents of 6 subjects positive for B*2709 were also typed for HLA class I and class II alleles. Statistical analysis was performed by Fisher's exact test. In Sardinia, the B27 alleles conferring susceptibility to AS appear to be more frequently carried by a haplotype (A2;B27;Cw2;DR16) that reaches its highest frequency in patients with AS (A2 80.8%, B27 100%, Cw2 83%, and DR16 74.5%). Conversely, the non–AS-associated B*2709 allele is more frequently found together with other HLA alleles whose frequencies are inversely correlated with the disease (A32 or A30, Cw1, and DR12). Familial analysis of 6 subjects positive for HLA–B*2709 confirmed the existence of a “Sardinian” haplotype that is not associated with AS (A32;B*2709;Cw1;DR12). In Sardinia, 2 distinct haplotypes harbor the non–AS-associated HLA–B*2709 allele or the AS-associated B27 alleles. Our findings are compatible with the hypothesis that other genes within the HLA region besides HLA–B27 may play some role in conferring susceptibility to AS. [ABSTRACT FROM AUTHOR]