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RESUMEN Objetivo: La actividad y el riesgo de recaída de la arteritis de Takayasu son bajos durante la gestación. Hasta el 40% de las pacientes puede tener desenlaces obstétricos desfavorables, por lo que es importante conocer su comportamiento clínico. Describimos las características clínicas y el desenlace obstétrico de gestantes con arteritis de Takayasu atendidas en un hospital de alta complejidad. Materiales y métodos: Evaluación retrospectiva de historias clínicas de gestantes con arteritis de Takayasu atendidas en el Hospital Universitario San Vicente Fundación de Medellín, Colombia, entre 2011 y 2018. Resultados: Se incluyó en el estudio a 6 pacientes con mediana de edad al diagnóstico de 17,5 arios (RI 9,25), al parto de 24 arios (RI 8,25) y con una duración de la enfermedad de 5,5 arios (RI 10,5). Del total, 3 pacientes tenían compromiso aórtico extenso; al parto, 3 pacientes estaban activas y requirieron inmunosupresores, 5 tenían hipertensión arterial, una desarrolló preeclampsia en el segundo trimestre, una tenía insuficiencia mitral y tricuspídea grave con disminución de la fracción de eyección del ventrículo izquierdo; 2 tenían aneurismas (arteria subclavia izquierda y aorta ascendente). Ningún embarazo resultó en aborto ni parto pretérmino; hubo 2 óbitos fetales, uno por restricción del crecimiento intrauterino e insuficiencia placentaria, y otro de etiología desconocida; ambas pacientes con actividad de la enfermedad, afección aórtica extensa e hipertensión arterial. Fueron por cesárea 5 partos por indicación materna; no hubo disección aórtica, rotura aneurismática ni hemorragia cerebral. Conclusión: Las pacientes con enfermedad activa y afección aórtica extensa presentaron resultados obstétricos desfavorables, lo que indica que el inadecuado control de la vasculitis genera mayores complicaciones materno-fetales. ABSTRACT Objective: The activity and risk of relapse of Takayasu's arteritis are low during pregnancy. Up to 40% of patients may have unfavorable obstetric outcomes therefore it is important to know their clinical behavior. We describe the clinical characteristics and obstetric outcome of pregnant women with Takayasu arteritis treated in a hospital of high complexity. Materials and methods: A retrospective evaluation of medical records of pregnant patients with Takayasu's arteritis treated at Hospital Universitario San Vicente Fundación in Medellin, Colombia between 2011 and 2018. Results: Six patients with a median age at diagnosis 17.5 (RI 9.25) years, at delivery 24 (RI 8.25) years, disease duration 5.5 (RI 10.5) years. Three patients had extensive aortic involvement; at delivery, 3 patients were active and required immunosuppressants, 5 had high blood pressure, one developed preeclampsia in the second trimester, one had severe mitral and tricuspid insufficiency with a decreased ejection fraction of the left ventricle; 2 had aneurysms (left subclavian artery and ascending aorta). No pregnancy resulted in abortion or preterm birth; there were 2 fetal deaths, one due to intrauterine growth restriction and placental insufficiency and another of unknown etiology; both patients with disease activity, extensive aortic condition, and arterial hypertension. Five deliveries were by cesarean section by maternal indication; there was no aortic dissection, aneurysmal rupture or cerebral hemorrhage. Conclusion: Patients with active disease and extensive aortic compromise presented unfavorable obstetric results, suggesting that inadequate control of vasculitis leads to greater maternal-fetal complications.

Background Up to 88% of cocaine is tainted with levamisole, an anthelmintic withdrawn from the market due to toxicity. Since 2010 levamisole-adulterated cocaine induced vasculopathy (LACIV) patients, characterised by retiform purpura, ear necrosis, multisystemic compromise and positivity for multiple autoantibodies, have been reported. Knowing the pattern and the severity of skin involvement is essential in the approach of these patients. Objectives To describe the cutaneous manifestations of patients with LACIV and to propose a classification of skin involvement. Methods We describe the skin compromise of 30 patients with LACIV evaluated between December 2010 and May 2017. Based on this series and the review of the literature, we propose a classification according to the distribution and severity of the lesions. Results All patients were mestizo, median age of 31 (IQR 27–38), male:female ratio 5:1, time from symptoms to diagnosis 12 months (IQR 6–24). The most frequent clinical manifestations were skin lesions: ear necrosis (73%) and retiform purpura (83%) affecting the extensor part of the limbs, buttocks, face, and abdomen; sparing the scalp, palms and soles. Retiform purpura was classified in four grades according to distribution and severity (image). Skin biopsies revealed leukocytoclastic vasculitis (24%), pseudo-vasculitis (19%), thrombotic vasculopathy with leukocytoclastic vasculitis (19%), thrombotic vasculopathy with pseudo-vasculitis (19%), and pyoderma gangrenosum with vasculopathy (5%). COL0010959

Background: Antineutrophil cytoplasmic antibodies (ANCA) are present in up to 90% granulomatosis with polyangiitis, 80% microscopic polyangiitis and 70% eosinophilic granulomatosis with polyangiitis. MPO-ANCA has been associated with vasculitis limited to the kidney, chronic renal damage and less frequent gastrointestinal or respiratory tract involvement. PR3-ANCA are characterised by destructive lesions of the ears, nose and throat, alveolar haemorrhage, combination of upper and/or lower respiratory tract involvement with renal compromise and increased number of relapses. The frequency of pulmonary involvement is similar in both serotypes, and most ANCA associated vasculitis (AAV) patients are diagnosed between ages 50 and 70 years. Objectives: To describe differences in clinical profiles of patients with AAV regarding ANCA specificity against MPO or PR3 in a Colombian based adult population Methods: All medical records of patients with a diagnosis of AAV in two high complexity hospitals in Medellín, Colombia from January 1, 2014 to December 31, 2016 were reviewed. The clinical and demographic characteristics were abstracted and analysed with descriptive and inferential statistics in SPSS.22 Results: Of 59 cases of AAV, 44 were positive for MPO or PR3-ANCA with male predominance (65.5% men vs 34.5% women) and similar age at diagnosis (47 years in MPO-ANCA vs 50 in PR3-ANCA). MPO-ANCA group had more fever and weight loss (34.8% vs 20%), arterial hypertension (34.5% vs 26.7%), hematuria (34.5% vs 26.7%), proteinuria (31% vs 26.7%), creatinin higher than 5.6 mg/dL (20.7 vs 13.3%), myalgias (13.8 vs 0%) pachymeningitis (7% vs 0%) and skin compromise. PR3-ANCA patients had more arthralgias/arthritis (40% vs 31%), escleritis (33% vs 13.8%), episcleritis (13.3% vs 0%) and uveítis (10% vs 7%). Conclusions: In this Latin American population ANCA specificity affected the phenotype of clinical disease. MPO-ANCA patients had more constitutional symptoms, renal and central nervous system compromise while PR3-ANCA patients showed more articular and ocular involvement. COL0010959

Background: Up to 88% of cocaine is tainted with levamisole, an anthelmintic withdrawn from the market due to toxicity. Since 2010 levamisole-adulterated cocaine vasculopathy (LACIV) patients, characterised by retiform purpura, ear necrosis, multisystemic compromise and positivity for multiple autoantibodies, have been reported. Renal involvement is the most serious and heterogeneous manifestation. Objectives: To describe the renal involvement of patients with LACIV. Methods: We describe the renal manifestations of 30 patients with LACIV evaluated from December 2010 to May 2017. Results: All patients were mestizo, median age of 31 (IQR 27–38), male:female ratio 5:1, time from symptoms to diagnosis 12 months (IQR 6–24). Nephritis found in 57%, creatinine elevation in 40%, median 1.85 mg/dl (IQR 1.2–4.0), 70% had proteinuria, median 3184 mg/day (IQR 552–5100), 58% in nephrotic-range; 88% had hematuria and 41% pyuria and cilindruria. Biopsy was performed in 7 patients (41%), showing immune complex mediated extracapillary glomerulonephritis (29%), membranous glomerulonephritis (29%), pauci-immune proliferative glomerulonephritis (14%), focal and segmental glomerulosclerosis (14%) and C3 mediated extracapillary glomerulonephritis (14%) (image). Three patients (10%) developed end-stage kidney disease. Image: A. Membranous glomerulonephritis: HE: glomerular thickened capillary walls, mild mesangial cellularity increase. B. GMS: capillary wall thickening and spikes (arrow). C. DIF: strong and diffuse IgG deposits on capillary walls. D. Immune complex mediated Extracapillary Focal Necrotizing Glomerulonephritis: HE: endocapillary proliferation, epithelial crescent (arrow). E. GMS: capillary wall rupture next to the crescent (arrow). F. DIF: Mesangial strong and diffuse IgG deposits. G. C3 mediated extracapillary glomerulonephritis: HE: glomerular capillary narrowing, epithelial crescent (arrow). H. GMS: normal capillary networks, epithelial crescent (arrow). I. DIF: C3 strong and diffuse positivity. J. Pauci-immune proliferative glomerulonephritis: PAS: epithelial crescents (arrows and asterisk). K. Trichrome: epithelial crescent (arrow). L. DIF for C3: weak deposits on capillary tuft. Non-immune complexes. M. Focal and segmental glomerulosclerosis: HE: segmental sclerosing lesions (arrow). N. PAS: segmental sclerosing lesions (asterisks). O. DIF for IgM: nonspecific positivity on a sclerotic segment. Conclusions: Although skin manifestations are the most characteristic and prevalent features in LIVEN, renal involvement is frequent, clinically and histologically heterogeneous, and potentially serious. The great heterogeneity on the histopathological findings suggests the participation of different physio-pathological mechanisms, establishing renal biopsy as necessary to identify the type of nephropathy and thus, optimal guidance of therapy. COL0010959

Los agentes biológicos inhibidores del factor de necrosis tumoral alfa (anti-TNF) se constituyen en un avance muy significativo en el tratamiento de los pacientes con espondilitis anquilosante (EA), demostrando una notable mejoría de sus síntomas, de su función y de su calidad de vida. Sumado a esta excelente respuesta clínica, se ha demostrado igualmente mejoría de la inflamación, demostrada mediante pruebas de laboratorio y estudios de resonancia nuclear magnética. A pesar de esta clara evidencia, la conexión entre actividad inflamatoria y progresión estructural no está tan claramente establecida como en artritis reumatoide (AR), y la evidencia de la eficacia de los anti-TNF en la prevención de la progresión del daño radiológico crónico en EA es deficiente. Se revisan las evidencias y las teorías actuales respecto a este crucial tema y se hace mención del importante papel de la proteína DKK-1, inhibidora de la vía Wnt. Esta proteína ha emergido recientemente como un regulador fundamental en la biología ósea y se constituye en una conexión clave entre inflamación, osteoporosis y remodelación articular. The anti-TNF biological agents constitute a major advance in the treatment of patients with ankylosing spondylitis (AS) showing a remarkable improvement in symptoms of patients, their function and quality of life. In addition to this excellent clinical response, it has also been clearly demonstrated improvement of inflammation as evidenced by laboratory tests and MRI studies. Despite this clear evidence, the connection between inflammatory activity and structural progression is not as clearly established as in rheumatoid arthritis, and the evidence of anti-TNF therapy to prevent chronic EA radiological damage is poor. We review the evidence and current theories about this crucial issue and mention the important role of DKK-1 protein, an inhibitor of the Wnt pathway. This protein has recently emerged as a key regulator in bone biology and constitutes a key link between inflammation, osteoporosis and joint remodeling.

RESUMEN: El lupus eritematoso sistémico ampolloso (LESA) es una manifestación infrecuente del lupus eritematoso sistémico (LES) causada por autoanticuerpos contra el colágeno tipo VII y otros componentes esenciales de la unión dermoepidérmica. Se presenta en pacientes que cumplen los criterios revisados de clasificación para LES del Colegio Americano de Reumatología y en presencia de alta actividad sistémica. El diagnóstico diferencial incluye otras enfermedades ampollosas autoinmunes como el penfigoide ampolloso, la epidermólisis ampollosa adquirida, la dermatosis ampollosa IgA lineal y la dermatitis herpetiforme las cuales también han sido informadas en LES. Palabras clave: Enfermedades Cutáneas Vesiculoampollosas; Lupus Cutáneo; Lupus Eritematoso Sistémico. ABSTRACT: Bullous systemic lupus erythematosus (BSLE) is an unusual cutaneous manifestation in systemic lupus erythematosus (SLE) caused by autoantibodies targeting type VII collagen and other essential constituents of the dermal-epidermal junction. This rare entity is observed in patients who meet the American College of Rheumatology revised criteria for SLE and usually in the context of increased systemic disease activity. Differential diagnoses of BSLE include other autoimmune bullous diseases such as bullous pemphigoid, epidermolysis bullosa acquisita, linear IgA bullous dermatosis and dermatitis herpetiformis which have also been reported in association with SLE. Key words: Bullous Skin Diseases; Cutaneous Lupus; Systemic Lupus Erythematosus.

Cuando se somete a cirugía a los pacientes con enfermedades reumáticas, una decisión difícil es si se suspende o no la medicación antirreumática durante el período perioperatorio. La mayor dificultad reside en lograr un equilibrio entre mantener el control de la enfermedad y optimizar la cicatrización de la herida quirúrgica, así como reducir al mínimo el riesgo de infección postoperatoria y el de otros tipos de morbilidad. En el presente manuscrito revisamos los datos disponibles sobre el uso de los glucocorticoides (GC), los medicamentos antirreumáticos modificadores de la enfermedad (DMARD) y los productos biológicos en el período perioperatorio de pacientes con enfermedades reumáticas. When patients with rheumatic diseases undergo surgery, a difficult decision is whether or not to suspend anti-rheumatic medication during the peri-operative period. The difficulty lay in striking a balance between maintaining control of the disease and optimizing wound healing along with minimizing the postoperative risk of infection and that of other morbidities. In this manuscript we review the available data on the use of glucocorticoids (GCs), diseasemodifying antirheumatic drugs (DMARDs) and biological agents in the peri-operative period of patients with rheumatic diseases.

A pesar de la asociación frecuentemente aceptada entre psoriasis e hiperuricemia existen pocos reportes de gota en pacientes con psoriasis y muchos menos frecuente el reporte de la coexistencia de gota y artritis psoriática. Reportamos el caso de un paciente con diagnósticos de artritis gotosa y artritis psoriática variedad espondiloartritis, y resaltamos que es la primera vez que se reporta esta asociación en la literatura. Despite the commonly accepted association between psoriasis and hyperuricemia there are few reports of gout in patients with psoriasis and many less frequent reporting the coexistence of gout and psoriatic arthritis. We report a patient diagnosed with gouty arthritis and psoriatic arthritis, spondylarthritis variety, and we emphasize that it is the first time that this association is reported in the literature.

El lupus eritematoso sistémico (LES) se asocia con diversos eventos adversos en el embarazo como parto prematuro, pre-eclampsia y pérdidas gestacionales. Gracias a los avances terapéuticos el pronóstico del embarazo en mujeres con LES ha mejorado. Además de las complicaciones relacionadas con el embarazo, las mujeres con LES tienen un alto riesgo de complicaciones médicas durante la gestación como hipertensión, enfermedad renal, síndrome antifosfolípido, diabetes pregestacional o actividad lúpica, las cuales afectan el curso de la enfermedad y empeoran los resultados del embarazo. El embarazo aumenta la probabilidad de recaídas del LES. Aunque no es posible predecir cuándo se presentará una recaída en una paciente, esta es más probable si la enfermedad ha permanecido activa en los seis meses previos a la concepción. Systemic lupus erythematosus (SLE) is associated with multiple adverse pregnancy outcomes, including fetal loss, preterm birth, and pre-eclampsia. With treatment advances, the prognosis of pregnancy in women with SLE has improved. In addition to complications related to pregnancy, SLE women are at increased risk for medical complications during pregnancy such as hypertension, renal disease, antiphospholipid syndrome, pregestational diabetes or active SLE which affect the course of the disease and worse the outcome of pregnancy. Pregnancy increases the likelihood of a lupus flare. It is not possible to predict when an individual patient will flare, although flare is more likely if disease has been active within six months of conception.

Las citocinas son moléculas de comunicación intercelular. Exhiben una gran cantidad de funciones en diferentes sistemas y procesos orgánicos; en particular, ejercen una acción muy importante en los mecanismos que producen la inflamación. La interleucina-6 es una molécula pleiotrópica con acciones proinflamatorias y antinflamatorias. Diversas fuentes de evidencia la vinculan de modo importante y directo con la fisiopatología de diferentes enfermedades autoinmunes. Este artículo revisa las bases moleculares y los diversos efectos biológicos de esta citoquina, así como la experiencia clínica acumulada hasta la fecha con terapias dirigidas al bloqueo de sus acciones proinflamatorias en pacientes con artritis reumatoide. Cytokines are intercellular communication molecules. They exhibit a great range of actions in different systems and organic processes, notably in the mechanisms that produce the inflammatory response. Interleukin-6 is a pleiotropic cytokine with both pro-inflammatory and anti-inflammatory functions. Evidence links this cytokine in an important and direct way with the pathophysiology of diverse autoimmune diseases, in particular, rheumatoid arthritis. This is a review of the molecular basis and the biological effects of interleukin-6. The clinical experience accumulated with therapies that block its pro-inflammatory actions in patients with rheumatoid arthritis are also included.

Informamos el caso de un hombre de 79 años con hemorragia alveolar, glomerulonefritis necrosante y polineuropatía por poliangiítis microscópica, una enfermedad autoinmune, caracterizada por vasculitis sistémica, predominantemente de vasos de pequeño calibre. Se revisan los aspectos clínicos y terapéuticos de la enfermedad. We report the case of a 79 years-old male, with alveolar hemorrhage, necrotizing glomerulonephritis and polyneuropathy due to microscopic polyangiitis, an autoimmune disease, characterized by systemic vasculitis, predominantly of small vessels. We review the clinical and therapeutic aspects of the disease.

A wide variety of rheumatic manifestations has been associated with malignancies. They may result from direct invasion of bone, joints or soft tissue by the tumor, and may also occur by distant effects of the tumor mediated by humoral factors (paraneoplastic syndromes). Among the paraneoplastic rheumatic syndromes, hyperthrophic ostearthropaty, carcinomatous polyarthritis, dermatomyositis and vasculitis are the most frequently diagnosed. Paraneoplastic syndromes may precede the tumor, by no longer than two years, appear simultaneously with it or follow its diagnosis. The clinical course usually is parallel to that of the tumor. Therefore, cure of the underlying malignancy often, although not invariably, results in regression of the paraneoplastic syndrome. In this article a review is presented on paraneoplastic rheumatic syndromes. RESUMEN: Una gran variedad de manifestaciones reumáticas han sido asociadas con las neoplasias. Se pueden deber a invasión tumoral directa a los huesos, articulaciones y tejidos blandos, y también aparecer por efectos a distancia del tumor mediados por factores humorales (síndromes paraneoplásicos). Entre los síndromes paraneoplásicos reumáticos los más comunes son la osteoartropatía hipertrófica, la poliartritis carcinomatosa, la dermatomiositis y las vasculitis. Los síndromes paraneoplásicos pueden anteceder al tumor, en no más de dos años, aparecer simultáneamente con él o luego del diagnóstico. Su curso clínico habitualmente es paralelo al del tumor. Por ende, la curación de la neoplasia usualmente, aunque no en todos los casos, resulta en la resolución del síndrome paraneoplásico. En este artículo se presenta una revisión sobre los síndromes paraneoplásicos reumáticos.

Las miopatías inflamatorias idiopáticas son el mayor grupo de miopatías adquiridas. Con base en los hallazgos clínicos, histopatológicos, inmunológicos y demográficos pueden ser diferenciadas en tres diferentes subgrupos: dermatomiositis, polimiositis y miositis por cuerpos de inclusión. El compromiso pulmonar es cada vez más reconocido como una complicación grave y una causa frecuente de morbilidad y mortalidad en estas enfermedades. Existen tres categorías de complicaciones pulmonares en miositis inflamatoria: neumonía por aspiración, hipoventilación y enfermedad pulmonar intersticial. La falla respiratoria causada por hipoventilación es una complicación poco común de las miopatías inflamatorias, la cual se presenta en pacientes con debilidad muscular generalizada e inflamación de los músculos respiratorios de inspiración y espiración. La debilidad del diafragma es probablemente una manifestación frecuente e ignorada en las miopatías inflamatorias. Reportamos el caso de una mujer con miopatía inflamatoria en quien los hallazgos de la electromiografía de músculos diafragmas demostraron compromiso inflamatorio de este músculo. The idiopathic inflammatory myopathies are the largest group of acquired myopathies. On the basis of clinical, histopathological, immunological and demographic features, they can be differentiated into three distinct subsets: dermatomyositis, polymyositis and inclusion-body myositis. Pulmonary involvement is increasingly recognized to be a serious complication and a common cause of morbidity and mortality in these diseases. There are three categories of pulmonary complications in inflammatory myositis: aspiration pneumonia, hypoventilation, and interstitial lung disease. Respiratory failure caused by hypoventilation is considered to be an uncommon complication of inflammatory myositis which occurs in patients with severe generalized muscle weakness and inflammation of inspiratory and expiratory respiratory muscles. Diaphragm weakness is frequent and probably overlooked in inflammatory myopathies. We report the case of a woman with inflammatory myopathy in whom the findings of the diaphragm muscles electromyography demonstrated inflammatory involvement of this muscle.

Objetivo: la actividad del lupus eritematoso sistémico (LES) tiende a disminuir en pacientes que desarrollan enfermedad renal crónica terminal (ERCT). Sin embargo, la actividad extrarrenal no es infrecuente, especialmente en los primeros años de la diálisis. Nosotros estudiamos el curso clínico y evaluamos la actividad del LES en pacientes con ERCT en diálisis por más de seis meses. El objetivo de este estudio fue identificar los factores asociados con actividad lúpica durante la diálisis. Métodos: se evaluaron retrospectivamente 15 pacientes con diagnóstico de LES quienes recibieron diálisis de mantenimiento en nuestro centro desde 2000 a 2009. Revisamos sus características clínicas, marcadores serológicos de actividad lúpica y actividad de la enfermedad según el SLEDAI. Se compararon los pacientes que presentaron exacerbaciones con quienes no presentaron exacerbaciones del lupus durante la diálisis de mantenimiento. Resultados: el tiempo transcurrido entre el diagnóstico del LES y el inicio de la diálisis fue de 40.3 meses (6.3-84.3) y la duración de la diálisis fue de 21.8 meses (12.0-40.0). Ocho pacientes presentaron nueve episodios de exacerbación del LES durante la diálisis. Cuatro (44.4%) se presentaron durante el primer año de la diálisis. En comparación con las otras siete pacientes que no tuvieron exacerbaciones durante la diálisis, las pacientes con exacerbaciones fueron más jóvenes al inicio de la diálisis [22.4 años (17.9 - 24.9) vs 30.6 años (26.2 - 40.1); p = 0.021] y tuvieron niveles séricos de C3 significativamente menores al inicio de la diálisis [63.5 mg/dl (57.5 - 67.5) vs 90 mg/dl (87.5 - 105), p = 0.006]. Conclusión: la actividad lúpica no siempre se "apaga" en pacientes que progresan a ERCT. Pacientes con una edad más joven y niveles más bajos de C3 al inicio de la diálisis pueden tener un mayor riesgo de presentar exacerbaciones del lupus durante la diálisis. Se recomienda un seguimiento cuidadoso de los pacientes lúpicos que reciben terapia dialítica mediante un monitoreo clínico y serológico, particularmente para aquellos considerados como potenciales receptores de trasplante renal. Objective: the activity of systemic lupus erythematosus (SLE) tends to decline in patients who develop end-stage renal disease (ESRD). However, extrarenal activity is not uncommon, particularly during the first few years of dialysis. We studied the clinical course and assessed the SLE activity in patients with ESRD on dialysis for more than six months. The objective of this study was to identify factors associated with postdialysis activity. Methods: fifteen patients with SLE who were given maintenance dialysis in our center from 2000 to 2007 were examined retrospectively. Their clinical characteristics, serological markers of disease activity and disease activity as per systemic lupus erythematosus disease activity (SLEDAI) were reviewed. Patients with and without postdialysis lupus flares were compared. Results: the time between SLE diagnosis and the onset of dialysis was 40.3 months (6.3-84.3) and the duration of dialysis was 21.8 months (12.0-40.0). Eight patients experienced 9 lupus postdialysis flares. Four flares (44.4%) occurred within the first year of dialysis. Compared with the other 7 patients who had no flares during dialysis, patients with flares were younger at the onset of dialysis [22.4 years (17.9 - 24.9) vs 30.6 years (26.2 - 40.1); p = 0.021] and had serum levels of C3 significantly lower at the onset of dialysis [63.5 mg/dl (57.5 - 67.5) vs 90 mg/dl (87.5 - 105), p = 0.006]. Conclusion: lupus activity does not always "burn out" in patients who progress to ESRD. Younger patients at the onset of dialysis and lower levels of C3 at the start of dialysis may have higher risk of postdialysis lupus flare. SLE patients on dialysis should be carefully followed up by clinical and serological monitoring, particularly in potential renal transplant recipients.