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Krustev E, Hanly JG, Chin R, Buhler KA, Urowitz MB, Gordon C, Bae SC, Romero-Diaz J, Sánchez-Guerrero J, Bernatsky S, Wallace DJ, Isenberg D, Rahman A, Merrill JT, Fortin PR, Gladman DD, Bruce IN, Petri MA, Ginzler EM, Dooley MA, Ramsey-Goldman R, Manzi S, Jönsen A, Alarcón GS, van Vollenhoven RF, Aranow C, Mackay M, Ruiz-Irastorza G, Lim S, Inanc M, Kalunian KC, Jacobsen S, Peschken CA, Kamen DL, Askenase A, Buyon J, Fritzler MJ, Clarke AE, Choi MY. Anti-KIF20B autoantibodies are associated with cranial neuropathy in systemic lupus erythematosus. Lupus Sci Med 2024; 11:e001139. [PMID: 38599670 PMCID: PMC11015279 DOI: 10.1136/lupus-2023-001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/20/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Cranial neuropathies (CN) are a rare neuropsychiatric SLE (NPSLE) manifestation. Previous studies reported that antibodies to the kinesin family member 20B (KIF20B) (anti-KIF20B) protein were associated with idiopathic ataxia and CN. We assessed anti-KIF20B as a potential biomarker for NPSLE in an international SLE inception cohort. METHODS Individuals fulfilling the revised 1997 American College of Rheumatology (ACR) SLE classification criteria were enrolled from 31 centres from 1999 to 2011 and followed annually in the Systemic Lupus Erythematosus International Collaborating Clinics inception cohort. Anti-KIF20B testing was performed on baseline (within 15 months of diagnosis or first annual visit) samples using an addressable laser bead immunoassay. Logistic regression (penalised maximum likelihood and adjusting for confounding variables) examined the association between anti-KIF20B and NPSLE manifestations (1999 ACR case definitions), including CN, occurring over the first 5 years of follow-up. RESULTS Of the 1827 enrolled cohort members, baseline serum and 5 years of follow-up data were available on 795 patients who were included in this study: 29.8% were anti-KIF20B-positive, 88.7% female, and 52.1% White. The frequency of anti-KIF20B positivity differed only for those with CN (n=10) versus without CN (n=785) (70.0% vs 29.3%; OR 5.2, 95% CI 1.4, 18.5). Compared with patients without CN, patients with CN were more likely to fulfil the ACR haematological (90.0% vs 66.1%; difference 23.9%, 95% CI 5.0%, 42.8%) and ANA (100% vs 95.7%; difference 4.3%, 95% CI 2.9%, 5.8%) criteria. In the multivariate analysis adjusting for age at baseline, female, White race and ethnicity, and ACR haematological and ANA criteria, anti-KIF20B positivity remained associated with CN (OR 5.2, 95% CI 1.4, 19.1). CONCLUSION Anti-KIF20B is a potential biomarker for SLE-related CN. Further studies are needed to examine how autoantibodies against KIF20B, which is variably expressed in a variety of neurological cells, contribute to disease pathogenesis.
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Affiliation(s)
- Eugene Krustev
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ricky Chin
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Katherine A Buhler
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Murray B Urowitz
- Lupus Program, Centre for Prognosis Studies in The Rheumatic Disease and Krembil Research Institute, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology and Hanyang Institute of Bioscience and Biotechnology, Seoul, Republic of Korea
| | - Juanita Romero-Diaz
- Immunology and Rheumatology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Mexico
| | | | - Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Daniel J Wallace
- Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - David Isenberg
- Centre for Rheumatology, Department of Medicine, University College London, London, UK
| | - Anisur Rahman
- Centre for Rheumatology, Department of Medicine, University College London, London, UK
| | - Joan T Merrill
- Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Paul R Fortin
- Division of Rheumatology, CHU de Québec, Universite Laval, Quebec City, Quebec, Canada
| | - Dafna D Gladman
- Lupus Program, Centre for Prognosis Studies in The Rheumatic Disease and Krembil Research Institute, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ian N Bruce
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and The Kellgren Centre for Rheumatology, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Michelle A Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ellen M Ginzler
- Medicine, SUNY Downstate Medical Center, New York City, New York, USA
| | - Mary Anne Dooley
- Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Susan Manzi
- Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Andreas Jönsen
- Department of Rheumatology, Lund University Department of Clinical Sciences Lund, Lund, Sweden
| | - Graciela S Alarcón
- Department of Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Ronald F van Vollenhoven
- Department of Rheumatology and Clinical Immunology, University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Cynthia Aranow
- Center for Autoimmune and Musculoskeletal Disease, Northwell Health Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Meggan Mackay
- Center for Autoimmune and Musculoskeletal Disease, Northwell Health Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Sam Lim
- Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Fatih, Turkey
| | - Kenneth C Kalunian
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - Søren Jacobsen
- Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Diane L Kamen
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Anca Askenase
- Columbia University Medical Center, New York City, New York, USA
| | - Jill Buyon
- Rheumatology, NYU Langone Health, New York City, New York, USA
| | - Marvin J Fritzler
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ann E Clarke
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - May Y Choi
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada
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2
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Nguyen Y, Blanchet B, Urowitz MB, Hanly JG, Gordon C, Bae S, Romero‐Diaz J, Sanchez‐Guerrero J, Clarke AE, Bernatsky S, Wallace DJ, Isenberg DA, Rahman A, Merrill JT, Fortin PR, Gladman DD, Bruce IN, Petri M, Ginzler EM, Dooley MA, Ramsey‐Goldman R, Manzi S, Jönsen A, Alarcón GS, Van Vollenhoven RF, Aranow C, Le Guern V, Mackay M, Ruiz‐Irastorza G, Lim SS, Inanc M, Kalunian KC, Jacobsen S, Peschken CA, Kamen DL, Askanase A, Buyon J, Costedoat‐Chalumeau N. Association Between Severe Nonadherence to Hydroxychloroquine and Systemic Lupus Erythematosus Flares, Damage, and Mortality in 660 Patients From the SLICC Inception Cohort. Arthritis Rheumatol 2023; 75:2195-2206. [PMID: 37459273 PMCID: PMC10792124 DOI: 10.1002/art.42645] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/05/2023] [Accepted: 06/29/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE The goals of this study were to assess the associations of severe nonadherence to hydroxychloroquine (HCQ), objectively assessed by HCQ serum levels, and risks of systemic lupus erythematosus (SLE) flares, damage, and mortality rates over five years of follow-up. METHODS The Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort is an international multicenter initiative (33 centers throughout 11 countries). The serum of patients prescribed HCQ for at least three months at enrollment were analyzed. Severe nonadherence was defined by a serum HCQ level <106 ng/mL or <53 ng/mL for HCQ doses of 400 or 200 mg/day, respectively. Associations with the risk of a flare (defined as a Systemic Lupus Erythematosus Disease Activity Index 2000 increase ≥4 points, initiation of prednisone or immunosuppressive drugs, or new renal involvement) were studied with logistic regression, and associations with damage (first SLICC/American College of Rheumatology Damage Index [SDI] increase ≥1 point) and mortality with separate Cox proportional hazard models. RESULTS Of the 1,849 cohort participants, 660 patients (88% women) were included. Median (interquartile range) serum HCQ was 388 ng/mL (244-566); 48 patients (7.3%) had severe HCQ nonadherence. No covariates were clearly associated with severe nonadherence, which was, however, independently associated with both flare (odds ratio 3.38; 95% confidence interval [CI] 1.80-6.42) and an increase in the SDI within each of the first three years (hazard ratio [HR] 1.92 at three years; 95% CI 1.05-3.50). Eleven patients died within five years, including 3 with severe nonadherence (crude HR 5.41; 95% CI 1.43-20.39). CONCLUSION Severe nonadherence was independently associated with the risks of an SLE flare in the following year, early damage, and five-year mortality.
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Affiliation(s)
- Yann Nguyen
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP‐HP Centre and Université Paris Cité and Centre de Recherche en Epidémiologie et Statistiques (CRESS), Unité Inserm 1153, Université de Paris CitéParisFrance
| | - Benoît Blanchet
- Biologie du médicament‐Toxicologie, AP‐HP Centre–Hôpital Cochin, Université Paris Cité, and UMR8038 CNRS, U1268 INSERM, Université Paris Cité, PRES Sorbonne Paris Cité, CARPEMParisFrance
| | | | - John G. Hanly
- Queen Elizabeth II Health Sciences Centre and Dalhousie UniversityHalifaxNova ScotiaCanada
| | - Caroline Gordon
- Institute of Inflammation and Ageing, University of BirminghamBirminghamUnited Kingdom
| | - Sang‐Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology, and Hanyang University Institute of Bioscience and BiotechnologySeoulKorea
| | | | | | - Ann E. Clarke
- Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | | | | | | | | | | | | | - Dafna D. Gladman
- Toronto Western Hospital, University of TorontoTorontoOntarioCanada
| | - Ian N. Bruce
- NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Center and Centre for Epidemiology Versus Arthritis, The University of ManchesterManchesterUK
| | - Michelle Petri
- Johns Hopkins University School of MedicineBaltimoreMaryland
| | | | - Mary Anne Dooley
- Thurston Arthritis Research Center, University of North CarolinaChapel Hill
| | | | - Susan Manzi
- Allegheny Health NetworkPittsburghPennsylvania
| | | | | | | | - Cynthia Aranow
- Feinstein Institute for Medical ResearchManhassetNew York
| | - Véronique Le Guern
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP‐HP Centre, Université Paris CitéParisFrance
| | - Meggan Mackay
- Feinstein Institute for Medical ResearchManhassetNew York
| | | | - S. Sam Lim
- Emory University School of MedicineAtlantaGeorgia
| | | | | | - Søren Jacobsen
- Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | | | | | - Anca Askanase
- Hospital for Joint Diseases and, Seligman Centre for Advanced Therapeutics, New York UniversityNew York City
| | - Jill Buyon
- New York University School of MedicineNew York City
| | - Nathalie Costedoat‐Chalumeau
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP‐HP Centre and Université Paris Cité and Centre de Recherche en Epidémiologie et Statistiques (CRESS), Unité Inserm 1153, Université de Paris CitéParisFrance
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3
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Tang TS, Liao F, Webber D, Gold N, Cao J, Dominguez D, Gladman D, Knight A, Levy DM, Ng L, Paterson AD, Touma Z, Urowitz MB, Wither J, Silverman ED, Pullenayegum EM, Hiraki LT. Genetics of longitudinal kidney function in children and adults with systemic lupus erythematosus. Rheumatology (Oxford) 2023; 62:3749-3756. [PMID: 36916720 PMCID: PMC10629779 DOI: 10.1093/rheumatology/kead119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/30/2023] [Accepted: 03/04/2023] [Indexed: 03/15/2023] Open
Abstract
OBJECTIVES Genome-wide association studies (GWAS) have identified loci associated with estimated glomerular filtration rate (eGFR). Few LN risk loci have been identified to date. We tested the association of SLE and eGFR polygenic risk scores (PRS) with repeated eGFR measures from children and adults with SLE. METHODS Patients from two tertiary care lupus clinics that met ≥4 ACR and/or SLICC criteria for SLE were genotyped on the Illumina MEGA or Omni1-Quad arrays. PRSs were calculated for SLE and eGFR, using published weighted GWA-significant alleles. eGFR was calculated using the CKD-EPI and Schwartz equations. We tested the effect of eGFR- and SLE-PRSs on eGFR mean and variance, adjusting for age at diagnosis, sex, ancestry, follow-up time, and clinical event flags. RESULTS We included 1158 SLE patients (37% biopsy-confirmed LN) with 36 733 eGFR measures over a median of 7.6 years (IQR: 3.9-15.3). LN was associated with lower within-person mean eGFR [LN: 93.8 (s.d. 26.4) vs non-LN: 101.6 (s.d. 17.7) mL/min per 1.73 m2; P < 0.0001] and higher variance [LN median: 157.0 (IQR: 89.5, 268.9) vs non-LN median: 84.9 (IQR: 46.9, 138.2) (mL/min per 1.73 m2)2; P < 0.0001]. Increasing SLE-PRSs were associated with lower mean eGFR and greater variance, while increasing eGFR-PRS was associated with increased eGFR mean and variance. CONCLUSION We observed significant associations between SLE and eGFR PRSs and repeated eGFR measurements, in a large cohort of children and adults with SLE. Longitudinal eGFR may serve as a powerful alternative outcome to LN categories for discovery of LN risk loci.
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Affiliation(s)
- Thai-Son Tang
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fangming Liao
- Genetics & Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Declan Webber
- Genetics & Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicholas Gold
- Genetics & Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jingjing Cao
- The Centre for Applied Genomics, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniela Dominguez
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dafna Gladman
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrea Knight
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Deborah M Levy
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence Ng
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew D Paterson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Genetics & Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zahi Touma
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Murray B Urowitz
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Joan Wither
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Earl D Silverman
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eleanor M Pullenayegum
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Linda T Hiraki
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Genetics & Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
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4
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Clarke AE, Hanly JG, Urowitz MB, St Pierre Y, Gordon C, Bae SC, Romero-Diaz J, Sanchez-Guerrero J, Bernatsky S, Wallace DJ, Isenberg DA, Rahman A, Merrill JT, Fortin PR, Gladman DD, Bruce IN, Petri M, Ginzler EM, Dooley MA, Ramsey-Goldman R, Manzi S, Jönsen A, Alarcón GS, Van Vollenhoven RF, Aranow C, Mackay M, Ruiz-Irastorza G, Lim SS, Inanc M, Kalunian KC, Jacobsen S, Peschken CA, Kamen DL, Askanase A, Farewell V. Assessing the Costs of Neuropsychiatric Disease in the Systemic Lupus International Collaborating Clinics Cohort Using Multistate Modeling. Arthritis Care Res (Hoboken) 2023; 75:1859-1870. [PMID: 36691838 PMCID: PMC10363569 DOI: 10.1002/acr.25090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 12/19/2022] [Accepted: 01/19/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To estimate direct and indirect costs associated with neuropsychiatric (NP) events in the Systemic Lupus International Collaborating Clinics inception cohort. METHODS NP events were documented annually using American College of Rheumatology definitions for NP events and attributed to systemic lupus erythematosus (SLE) or non-SLE causes. Patients were stratified into 1 of 3 NP states (no, resolved, or new/ongoing NP event). Change in NP status was characterized by interstate transition rates using multistate modeling. Annual direct costs and indirect costs were based on health care use and impaired productivity over the preceding year. Annual costs associated with NP states and NP events were calculated by averaging all observations in each state and adjusted through random-effects regressions. Five- and 10-year costs for NP states were predicted by multiplying adjusted annual costs per state by expected state duration, forecasted using multistate modeling. RESULTS A total of 1,697 patients (49% White race/ethnicity) were followed for a mean of 9.6 years. NP events (n = 1,971) occurred in 956 patients, 32% attributed to SLE. For SLE and non-SLE NP events, predicted annual, 5-, and 10-year direct costs and indirect costs were higher in new/ongoing versus no events. Direct costs were 1.5-fold higher and indirect costs 1.3-fold higher in new/ongoing versus no events. Indirect costs exceeded direct costs 3.0 to 5.2 fold. Among frequent SLE NP events, new/ongoing seizure disorder and cerebrovascular disease accounted for the largest increases in annual direct costs. For non-SLE NP events, new/ongoing polyneuropathy accounted for the largest increase in annual direct costs, and new/ongoing headache and mood disorder for the largest increases in indirect costs. CONCLUSION Patients with new/ongoing SLE or non-SLE NP events incurred higher direct and indirect costs.
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Affiliation(s)
| | - John G Hanly
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Murray B Urowitz
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Yvan St Pierre
- McGill University Health Center, Montreal, Quebec, Canada
| | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases and Hanyang University, Seoul, Republic of Korea
| | | | | | | | | | | | | | | | - Paul R Fortin
- CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Dafna D Gladman
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ian N Bruce
- The University of Manchester and Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ellen M Ginzler
- State University of New York Downstate Health Sciences University, Brooklyn
| | | | | | - Susan Manzi
- Alleghany Health Network, Pittsburgh, Pennsylvania
| | | | | | | | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | - Meggan Mackay
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | - S Sam Lim
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Soren Jacobsen
- Rigshospitalet and Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Anca Askanase
- Hospital for Joint Diseases and New York University Seligman Center for Advanced Therapeutics, New York, New York
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5
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Whittall-Garcia L, Gladman DD, Urowitz MB, Touma Z, Johnson SR. Correspondence on "relationship between the EULAR/ACR classification criteria and organ damage in systemic lupus erythematosus" by Chi Chiu Mok et al. Lupus 2023; 32:810-811. [PMID: 37125665 DOI: 10.1177/09612033231171365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Laura Whittall-Garcia
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Dafna D Gladman
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Murray B Urowitz
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Zahi Touma
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Sindhu R Johnson
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, Mount Sinai Hospital; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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6
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Alhammadi NA, Gladman DD, Su J, Urowitz MB. Isolated Neutropenia in Systemic Lupus Erythematosus. J Rheumatol 2023; 50:459-460. [PMID: 36243416 DOI: 10.3899/jrheum.220373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Lymphopenia is the most commonly found leukocyte abnormality in patients with systemic lupus erythematosus (SLE). Neutropenia prevalence varied from 20% to 40% in a systematic literature review.1
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Affiliation(s)
- Nouf A Alhammadi
- University of Toronto Lupus Clinic, Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario Canada.,King Khalid University, Abha, Saudi Arabia
| | - Dafna D Gladman
- University of Toronto Lupus Clinic, Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario Canada
| | - Jiandong Su
- University of Toronto Lupus Clinic, Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario Canada
| | - Murray B Urowitz
- University of Toronto Lupus Clinic, Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario Canada;
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7
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Urowitz MB, Aranow C, Asukai Y, Bass DL, Bruce IN, Chauhan D, Dall'Era M, Furie R, Fox NL, Gilbride JA, Hammer A, Ginzler EM, Gonzalez‐Rivera T, Levy RA, Merrill JT, Quasny H, Roth DA, Stohl W, van Vollenhoven R, Wallace DJ, Petri M. Impact of Belimumab on Organ Damage in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2022; 74:1822-1828. [PMID: 35439360 PMCID: PMC9805003 DOI: 10.1002/acr.24901] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/17/2022] [Accepted: 04/14/2022] [Indexed: 01/09/2023]
Abstract
Organ damage is a key determinant of poor long-term prognosis and early death in patients with systemic lupus erythematosus (SLE). Prevention of damage is a key treatment goal of the 2019 update of the European Alliance of Associations for Rheumatology (EULAR) recommendations for SLE management. Belimumab is a monoclonal antibody that inhibits B lymphocyte stimulator (BLyS) and is the only therapy approved for both SLE and lupus nephritis. Here, we review the clinical trial and real-world data on the effects of belimumab on organ damage in adult patients with SLE. Across 4 phase III studies, belimumab in combination with background SLE therapy demonstrated consistent reductions in key drivers of organ damage including disease activity, risk of new severe flares, and glucocorticoid exposure compared to background therapy alone. Long-term belimumab use in SLE also reduced organ damage progression measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, as reported in open-label extension studies, and propensity score-matched comparative analyses to background therapy alone. Results from a clinical trial showed that in patients with active lupus nephritis, belimumab treatment improved renal response, reduced the risk of renal-related events, and impacted features related to kidney damage progression compared to background therapy alone. The decrease of organ damage accumulation observed with belimumab treatment in SLE, including lupus nephritis, suggest a disease-modifying effect.
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Affiliation(s)
| | - Cynthia Aranow
- Feinstein Institutes for Medical ResearchManhassetNew York
| | | | | | - Ian N. Bruce
- The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUK
| | | | - Maria Dall'Era
- University of California San Francisco School of Medicine
| | | | | | | | | | - Ellen M. Ginzler
- State University of New York Downstate Health Sciences UniversityBrooklynNew York
| | | | | | | | | | | | - William Stohl
- University of Southern California Keck School of MedicineLos Angeles
| | - Ronald van Vollenhoven
- Amsterdam Rheumatology and Immunology Center, VU University Medical CenterAmsterdamThe Netherlands
| | - Daniel J. Wallace
- Cedars‐Sinai Medical Center, Los Angeles, California, and University of CaliforniaLos Angeles
| | - Michelle Petri
- Johns Hopkins University School of MedicineBaltimoreMaryland
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Johnson SR, Martinez JPD, Whittall-Garcia L, Urowitz MB, Gladman DD, Touma Z. Evaluating the threshold score for classification of systemic lupus erythematosus using the EULAR/ACR criteria. J Rheumatol 2022; 50:512-518. [PMID: 36319012 DOI: 10.3899/jrheum.220100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
ObjectiveTo evaluate if a change in EULAR/ACR SLE classification criteria threshold score impacts accurate classification of SLE compared to disease-based control subjects. We evaluated a range of threshold scores to determine the score that maximizes accurate classification of early SLE.MethodsWe conducted a cross-sectional study comparing SLE and control patients. A EULAR/ACR criteria score was calculated using baseline information. Sensitivity, specificity, (+LR) and (-LR) likelihood ratios with 95% confidence intervals were used to evaluate operating characteristics. Threshold scores of 6-12 were evaluated in subjects with early disease (disease duration of ≤5 years). +LR above 10 and -LR below 0.1 provide evidence to rule in or rule out SLE.Results2764 patients (1980 SLE cases who fulfilled either the ACR or SLICC criteria, 784 controls) were included. The EULAR/ACR SLE criteria had a sensitivity 98% (95%CI 97%, 98%), specificity 99% (95%CI 98%, 100%), +LR 95.5 (95%CI 48.0, 190) and -LR 0.03 (95%CI 0.02,0.03). The criteria operate well in early disease, women, men, and in Caucasian, Black, Chinese and Filipino ethnicities. A score of 10 maximizes accurate classification of patients with early disease +LR 174.4 (95%CI 43.8, 694.6) and -LR of 0.03 (95%CI 0.02, 0.04). An increase in threshold score from 10 to 11 results in significant worsening in -LR (threshold score 10 -LR 0.03 (95%CI 0.02 - 0.03 versus threshold score 11 -LR 0.05 (95%CI 0.04 - 0.06).ConclusionThe EULAR/ACR SLE classification criteria threshold score of 10 performs well particularly in early disease and across sexes and ethnicities.
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Cardwell FS, Elliott SJ, Chin R, St Pierre Y, Choi MY, Urowitz MB, Ruiz-Irastorza G, Bernatsky S, Wallace DJ, Petri MA, Manzi S, Bae SC, Shin JM, Mak A, Cho J, Peschken CA, Ramsey-Goldman R, Fortin PR, Hanly JG, Pons-Estel BA, Nieto R, Askanase AD, Romero-Diaz J, Mosca M, Bruce IN, Rowbottom L, Mielczarek L, Tse K, Marion A, Cáhiz-González JC, Cattoni TG, Cornet A, Clarke AE. Health information use by patients with systemic lupus erythematosus (SLE) pre and during the COVID-19 pandemic. Lupus Sci Med 2022; 9:9/1/e000755. [PMID: 36283746 PMCID: PMC9606736 DOI: 10.1136/lupus-2022-000755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/12/2022] [Indexed: 05/13/2023]
Abstract
OBJECTIVE We conducted an international survey of patients with SLE to assess their access, preference and trust in various health information sources pre-COVID-19 and during the COVID-19 pandemic. METHODS Patients with SLE were recruited from 18 observational cohorts, and patients self-reporting SLE were recruited through five advocacy organisations. Respondents completed an online survey from June 2020 to December 2021 regarding the sources of health information they accessed in the 12 months preceding (pre-11 March 2020) and during (post-11 March 2020) the pandemic. Multivariable logistic regressions assessed factors associated with accessing news and social media post-11 March 2020, and self-reporting negative impacts from health information accessed through these sources. RESULTS Surveys were completed by 2111 respondents; 92.8% were female, 76.6% had postsecondary education, mean (SD) age was 48.8 (14.0) years. Lupus specialists and family physicians were the most preferred sources pre-11 March 2020 and post-11 March 2020, yet were accessed less frequently (specialists: 78.5% pre vs 70.2% post, difference -8.3%, 95% CI -10.2% to -6.5%; family physicians: 57.1% pre vs 50.0% post, difference -7.1%, 95% CI -9.2% to -5.0%), while news (53.2% pre vs 62.1% post, difference 8.9%, 95% CI 6.7% to 11.0%) and social media (38.2% pre vs 40.6% post, difference 2.4%, 95% CI 0.7% to 4.2%) were accessed more frequently post-11 March 2020 vs pre-11 March 2020. 17.2% of respondents reported negative impacts from information accessed through news/social media. Those outside Canada, older respondents or with postsecondary education were more likely to access news media. Those in Asia, Latin America or younger respondents were more likely to access social media. Those in Asia, older respondents, males or with postsecondary education in Canada, Asia or the USA were less likely to be negatively impacted. CONCLUSIONS Physicians, the most preferred and trusted sources, were accessed less frequently, while news and social media, less trusted sources, were accessed more frequently post-11 March 2020 vs pre-11 March 2020. Increasing accessibility to physicians, in person and virtually, may help reduce the consequences of accessing misinformation/disinformation.
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Affiliation(s)
- Francesca S Cardwell
- Geography and Environmental Management, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan J Elliott
- Geography and Environmental Management, University of Waterloo, Waterloo, Ontario, Canada
| | - Ricky Chin
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yvan St Pierre
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - May Y Choi
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Murray B Urowitz
- Schroeder Arthritis Institute, Kremblin Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, BioCruces Bizkaia Health Research Institute, University of the Basque Country, Barakaldo, Bizkaia, Spain
| | - Sasha Bernatsky
- Department of Medicine and Centre for Outcomes Research & Evaluation, McGill University, Montreal, Quebec, Canada
| | - Daniel J Wallace
- Rheumatology, Cedars-Sinai Medical Center, West Hollywood, California, USA
| | - Michelle A Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Manzi
- Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Seoul Hospital, Seoul, The Republic of Korea
| | - Jung-Min Shin
- Department of Rheumatology, Hanyang University, Seongdong-gu, Seoul, The Republic of Korea
| | - Anselm Mak
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore
| | - Jiacai Cho
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Rheumatology, Department of Medicine, National University Hospital of Singapore, Singapore
| | - Christine A Peschken
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Paul R Fortin
- Medicine-Rheumatology, Centre Hospitalier de l'Université Laval, Quebec City, Quebec, Canada
| | - John G Hanly
- Division of Rheumatology, Department of Medicine, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bernardo A Pons-Estel
- Rheumatology, Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Rosario, Argentina
| | - Romina Nieto
- Department of Rheumatology, Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Rosario, Argentina
| | | | - Juanita Romero-Diaz
- Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Marta Mosca
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ian N Bruce
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK
| | - Leigha Rowbottom
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Karin Tse
- Lupus Foundation of America Inc, Washington, District of Columbia, USA
| | - Ashley Marion
- Lupus Foundation of America Inc, Washington, District of Columbia, USA
| | | | | | | | - Ann Elaine Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Whittall-Garcia L, Gladman DD, Urowitz MB, Su J, Touma Z, Johnson SR. The New EULAR/ACR 2019 SLE Classification Criteria: A predictor of long-term outcomes. Semin Arthritis Rheum 2022; 57:152103. [DOI: 10.1016/j.semarthrit.2022.152103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 10/14/2022]
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Papachristos DA, Gladman DD, Su J, Urowitz MB. Outcomes following antimalarial withdrawal in patients with quiescent systemic lupus erythematosus. Semin Arthritis Rheum 2022; 55:152046. [PMID: 35716465 DOI: 10.1016/j.semarthrit.2022.152046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Antimalarial medications (AMs) are central to the management of SLE. We investigated the rate of flare in lupus patients who withdrew AM after achieving clinical remission for at least one year, compared to those who continued therapy and compared flare rates in cases who tapered AM versus abruptly withdrew. METHODS Cases achieved clinical remission for at least one year then ceased their AM. Index date was defined as the date of complete AM cessation. Controls achieved clinical remission for at least one year and continued AM. Controls were matched according to the duration of AM before remission and the duration of therapy from remission date to case index date. All patients had ≥ 2 years of follow up. RESULTS Of 1573 patients on AM, 165 achieved a one-year remission and then ceased their AM. 96 had adequate follow-up, 88 were successfully matched to one control and 85 to 2 controls for a total of 173 controls. Flare occurred in 61.4% of cases and 45.1% of controls (p = 0.002). 52.3% patients who withdrew AM later restarted it due to disease flare. 88% recaptured control or improved, while 12% did not. Patients who tapered had significantly fewer flares (45.9% vs. 72.6%; p = 0.01). CONCLUSION AMs aid in preventing disease flare even in patients who have achieved prolonged clinical remission. Tapering AM results in lower flare rates. Hence, except in the setting of toxicity, cessation of antimalarial therapy in patients with prolonged disease quiescence is feasible using a slow taper.
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Affiliation(s)
- Danaë A Papachristos
- University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases University Health Network, Toronto Western Hospital, 399 Bathurst St. 1E-410B, Toronto, Ontario M5T 2S8, Canada
| | - Dafna D Gladman
- University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases University Health Network, Toronto Western Hospital, 399 Bathurst St. 1E-410B, Toronto, Ontario M5T 2S8, Canada; Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jiandong Su
- University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases University Health Network, Toronto Western Hospital, 399 Bathurst St. 1E-410B, Toronto, Ontario M5T 2S8, Canada
| | - Murray B Urowitz
- University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases University Health Network, Toronto Western Hospital, 399 Bathurst St. 1E-410B, Toronto, Ontario M5T 2S8, Canada; Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada.
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van Vollenhoven R, Askanase AD, Bomback AS, Bruce IN, Carroll A, Dall'Era M, Daniels M, Levy RA, Schwarting A, Quasny HA, Urowitz MB, Zhao MH, Furie R. Conceptual framework for defining disease modification in systemic lupus erythematosus: a call for formal criteria. Lupus Sci Med 2022; 9:9/1/e000634. [PMID: 35346982 PMCID: PMC8961173 DOI: 10.1136/lupus-2021-000634] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/03/2022] [Indexed: 12/15/2022]
Abstract
Disease modification has become a well-established concept in several therapeutic areas; however, no widely accepted definition of disease modification exists for SLE. We reviewed established definitions of disease modification in other conditions and identified a meaningful effect on ‘disease manifestations’ (ie, signs, symptoms and patient-reported outcomes) and on ‘disease outcomes’ (eg, long-term remission or progression of damage) as the key principles of disease modification, indicating a positive effect on the natural course of the disease. Based on these findings and the treatment goals and outcome measures for SLE, including lupus nephritis, we suggest a definition of disease modification based on disease activity indices and organ damage outcomes, with the latter as a key anchor. A set of evaluation criteria is also suggested. Establishing a definition of disease modification in SLE will clarify which treatments can be considered disease modifying, provide an opportunity to harmonise future clinical trial outcomes and enable comparison between therapies, all of which could ultimately help to improve patient outcomes. This publication seeks to catalyse further discussion and provide a framework to develop an accepted definition of disease modification in SLE.
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Affiliation(s)
- Ronald van Vollenhoven
- Amsterdam Rheumatology and Immunology Center and Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Andrew S Bomback
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Ian N Bruce
- The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Angela Carroll
- GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Maria Dall'Era
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - Roger A Levy
- GlaxoSmithKline, Philadelphia, Pennsylvania, USA
| | - Andreas Schwarting
- Rheumatology Center Rhineland Palatinate, Bad Kreuznach, Germany.,University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Holly A Quasny
- GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | | | - Ming-Hui Zhao
- Peking University First Hospital, Peking-Tsinghua Center for Life Sciences, Beijing, China
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13
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Urowitz MB, Ohsfeldt RL, Wielage RC, Dever JJ, Zakerifar M, Asukai Y, Ramachandran S, Joshi AV. Comparative analysis of long-term organ damage in patients with systemic lupus erythematosus using belimumab versus standard therapy: a post hoc longitudinal study. Lupus Sci Med 2021; 7:7/1/e000412. [PMID: 33051264 PMCID: PMC7555104 DOI: 10.1136/lupus-2020-000412] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/07/2020] [Accepted: 09/03/2020] [Indexed: 01/08/2023]
Abstract
Objective Long-term extension (LTE) studies of belimumab in SLE do not include a comparator arm, preventing comparisons between belimumab plus standard therapy and standard therapy alone for organ damage accrual. Propensity score matching can be used to match belimumab-treated patients from LTE studies with standard therapy–treated patients from observational cohort studies. This analysis was designed to compare organ damage progression between treatment groups (belimumab plus standard therapy vs standard therapy alone) in patients with SLE with ≥5 years of follow-up, reproducing our previous study with more generalisable data. Methods This exploratory post hoc analysis used a heterogeneous population of US and non-US patients receiving monthly intravenous belimumab from pooled BLISS LTE trials (BEL112234/NCT00712933) and standard therapy–treated patients from the Toronto Lupus Cohort. Sixteen clinical variables were selected to calculate the propensity score. Results The 592 LTE and 381 Toronto Lupus Cohort patients were highly dissimilar across the 16 variables; an adequately balanced sample of 181 LTE and 181 matched Toronto Lupus Cohort patients (mean bias=3.7%) was created using propensity score matching. Belimumab treatment was associated with a smaller increase in Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) over 5 years than standard therapy alone (mean treatment difference=–0.453 (95% CI –0.646 to –0.260); p<0.001). Patients treated with belimumab were 60% less likely to progress to a higher SDI score over any given year of follow-up, compared with standard therapy alone (HR (95% CI) 0.397 (0.275 to 0.572); p<0.001). Conclusion Using propensity score matching, this highly heterogeneous sample was sufficiently matched to the Toronto Lupus Cohort, suggesting that patients treated with intravenous belimumab may have reduced organ damage progression versus standard therapy alone. This analysis of a large and diverse pooled SLE population was consistent with our previously published US-focused study.
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Affiliation(s)
- Murray B Urowitz
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Robert L Ohsfeldt
- School of Public Health, Texas A&M University, College Station, Texas, USA
| | | | - John J Dever
- Medical Decision Modeling Inc, Indianapolis, Indiana, USA
| | | | - Yumi Asukai
- Value Evidence & Outcomes, GlaxoSmithKline, Brentford, UK
| | | | - Ashish V Joshi
- Value Evidence & Outcomes, GlaxoSmithKline, Collegeville, Pennsylvania, USA
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Touma Z, Gladman DD, Zandy M, Su J, Anderson N, Urowitz MB. Identifying a Response for the Systemic Lupus Erythematosus Disease Activity 2000 Glucocorticoid Index. Arthritis Care Res (Hoboken) 2021; 73:1243-1249. [DOI: 10.1002/acr.24261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 04/02/2020] [Accepted: 05/12/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Zahi Touma
- University of Toronto Lupus Clinic Centre for Prognosis Studies in Rheumatic Diseases Toronto Western Hospital Toronto Ontario Canada
| | - Dafna D. Gladman
- University of Toronto Lupus Clinic Centre for Prognosis Studies in Rheumatic Diseases Toronto Western Hospital Toronto Ontario Canada
| | - Moe Zandy
- University of Toronto Lupus Clinic Centre for Prognosis Studies in Rheumatic Diseases Toronto Western Hospital Toronto Ontario Canada
| | - Jiandong Su
- University of Toronto Lupus Clinic Centre for Prognosis Studies in Rheumatic Diseases Toronto Western Hospital Toronto Ontario Canada
| | - Nicole Anderson
- University of Toronto Lupus Clinic Centre for Prognosis Studies in Rheumatic Diseases Toronto Western Hospital Toronto Ontario Canada
| | - Murray B. Urowitz
- University of Toronto Lupus Clinic Centre for Prognosis Studies in Rheumatic Diseases Toronto Western Hospital Toronto Ontario Canada
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15
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Tselios K, Gladman DD, Su J, Urowitz MB. Gradual Glucocorticosteroid Withdrawal Is Safe in Clinically Quiescent Systemic Lupus Erythematosus. ACR Open Rheumatol 2021; 3:550-557. [PMID: 34245233 PMCID: PMC8363847 DOI: 10.1002/acr2.11267] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives Patients with systemic lupus erythematosus (SLE) are usually treated with glucocorticosteroids even during periods of clinically quiescent disease. A recent study showed that abrupt glucocorticoid withdrawal was associated with an increased likelihood of flare in the next 12 months. The aim of the present study was to assess clinical flare rates and damage accrual in patients who tapered glucocorticosteroids gradually. Methods Patients from the Toronto Lupus Clinic with 2 consecutive years of clinically quiescent disease were retrieved from the database. Individuals who maintained a low prednisone dose (5 mg/day) comprised the maintenance group, whereas patients who gradually tapered prednisone within these two years comprised the withdrawal group. All individuals were followed for 2 years after prednisone discontinuation or the corresponding date for the maintenance group. Propensity score matching was implemented to adjust for certain baseline differences. Outcomes included clinical flares and damage accrual. Results Of 270 eligible patients, 204 were matched (102 in each group). Flare rate (any increase in clinical SLE Disease Activity Index 2000) was lower in the withdrawal group both at 12 (17.6% versus 29.4%; P = 0.023) and 24 months (33.3% versus 50%; P = 0.01). Moderate to severe flares (requiring systemic treatment escalation) were not different at 12 months (10.8% versus 13.7%; P = 0.467) but were less frequent at 24 months (14.7% versus 27.5%; P = 0.024). Damage accrual was less frequent in the withdrawal group (6.9% versus 17.6%; P = 0.022). No predictors for clinical flares were identified. Conclusion Gradual glucocorticoid withdrawal is safe in clinically quiescent SLE and is associated with fewer clinical flares and less damage accrual at 24 months.
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Affiliation(s)
- Konstantinos Tselios
- University of Toronto Lupus ClinicCentre of Prognosis Studies in the Rheumatic DiseasesUniversity Health NetworkTorontoOntarioCanada
| | - Dafna D. Gladman
- University of Toronto Lupus ClinicCentre of Prognosis Studies in the Rheumatic DiseasesUniversity Health NetworkTorontoOntarioCanada
| | - Jiandong Su
- University of Toronto Lupus ClinicCentre of Prognosis Studies in the Rheumatic DiseasesUniversity Health NetworkTorontoOntarioCanada
| | - Murray B. Urowitz
- University of Toronto Lupus ClinicCentre of Prognosis Studies in the Rheumatic DiseasesUniversity Health NetworkTorontoOntarioCanada
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Hanly JG, Gordon C, Bae SC, Romero-Diaz J, Sanchez-Guerrero J, Bernatsky S, Clarke AE, Wallace DJ, Isenberg DA, Rahman A, Merrill JT, Fortin PR, Gladman DD, Urowitz MB, Bruce IN, Petri M, Ginzler EM, Dooley MA, Ramsey-Goldman R, Manzi S, Jonsen A, Alarcón GS, van Vollenhoven RF, Aranow C, Mackay M, Ruiz-Irastorza G, Lim SS, Inanc M, Kalunian KC, Jacobsen S, Peschken CA, Kamen DL, Askanase A, Farewell V. Neuropsychiatric Events in Systemic Lupus Erythematosus. Arthritis Rheumatol 2021; 73:2293-2302. [PMID: 34042329 DOI: 10.1002/art.41876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/13/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To determine predictors for change in neuropsychiatric (NP) event status in a large, prospective, international, inception cohort of SLE patients METHODS: Upon enrollment and annually thereafter, NP events attributed to SLE and non-SLE causes and physician determined resolution were documented. Factors potentially associated with onset and resolution of NP events were determined by time-to-event analysis using a multistate modelling structure. RESULTS NP events occurred in 955/1,827 (52.3%) patients and 592/1910 (31.0%) unique events were attributed to SLE. For SLE NP events multivariate analysis revealed positive associations with male sex, concurrent non-SLE NP events excluding headache, active SLE and corticosteroids. There was a negative association with Asian race/ethnicity, post-secondary education, and immunosuppressive or anti-malarial drugs. For non-SLE NP events, excluding headache, there was a positive association with concurrent SLE NP events and negative associations with African and Asian race/ethnicity. NP events attributed to SLE had a higher resolution rate than non-SLE NP events, with the exception of headache that had comparable resolution rates. For SLE NP events, multivariate analysis revealed resolution was more common with Asian race/ethnicity and for central/focal NP events. For non-SLE NP events resolution was more common with African race/ethnicity and less common with older age at SLE diagnosis. CONCLUSIONS In a large and long-term study of the occurrence and resolution of NP events in SLE we identified subgroups with better and worse prognosis. The course of NP events differs greatly depending on their nature and attribution.
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Affiliation(s)
- John G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | | | | | - Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ann E Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Daniel J Wallace
- Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - David A Isenberg
- Centre for Rheumatology, Department of Medicine, University College London, UK
| | - Anisur Rahman
- Centre for Rheumatology, Department of Medicine, University College London, UK
| | - Joan T Merrill
- Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Paul R Fortin
- Division of Rheumatology, Department of Medicine, CHU de Québec - Université Laval, Quebec City, Canada
| | - Dafna D Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, ON, Canada
| | - Murray B Urowitz
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, ON, Canada
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre Manchester, UK
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ellen M Ginzler
- Department of Medicine, SUNY Downstate Medical Centre, Brooklyn, NY, USA
| | - M A Dooley
- Thurston Arthritis Research Centre, University of North Carolina, Chapel Hill, NC, USA
| | | | - Susan Manzi
- Lupus Centre of Excellence, Allegheny Health Network, Pittsburgh, PA, USA
| | - Andreas Jonsen
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - Graciela S Alarcón
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ronald F van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centres, Amsterdam, Holland, USA
| | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Meggan Mackay
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - S Sam Lim
- Emory University, Department of Medicine, Division of Rheumatology, Atlanta, Georgia, USA
| | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | | | - Soren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Diane L Kamen
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Anca Askanase
- Hospital for Joint Diseases, NYU, Seligman Centre for Advanced Therapeutics, New York, NY, USA
| | - Vernon Farewell
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
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Sivakumaran J, Harvey P, Omar A, Tayer-Shifman O, Urowitz MB, Gladman DD, Anderson N, Su J, Touma Z. Assessment of cardiovascular risk tools as predictors of cardiovascular disease events in systemic lupus erythematosus. Lupus Sci Med 2021; 8:8/1/e000448. [PMID: 34045359 PMCID: PMC8162102 DOI: 10.1136/lupus-2020-000448] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 05/06/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND SLE is an independent risk factor for cardiovascular disease (CVD). This study aimed to determine which among QRISK2, QRISK3, Framingham Risk Score (FRS), modified Framingham Risk Score (mFRS) and SLE Cardiovascular Risk Equation (SLECRE) best predicts CVD. METHODS This is a single-centre analysis on 1887 patients with SLE followed prospectively according to a standard protocol. Tools' scores were evaluated against CVD development at/within 10 years for patients with CVD and without CVD. For patients with CVD, the index date for risk score calculation was chosen as close to 10 years prior to CVD event. For patients without CVD, risk scores were calculated as close to 10 years prior to the most recent clinic appointment. Proportions of low-risk (<10%), intermediate-risk (10%-20%) and high-risk (>20%) patients for developing CVD according to each tool were determined, allowing sensitivity, specificity, positive/negative predictive value and concordance (c) statistics analysis. RESULTS Among 1887 patients, 232 CVD events occurred. QRISK2 and FRS, and QRISK3 and mFRS, performed similarly. SLECRE classified the highest number of patients as intermediate and high risk. Sensitivities and specificities were 19% and 93% for QRISK2, 22% and 93% for FRS, 46% and 83% for mFRS, 47% and 78% for QRISK3, and 61% and 64% for SLECRE. Tools were similar in negative predictive value, ranging from 89% (QRISK2) to 92% (SLECRE). FRS and mFRS had the greatest c-statistics (0.73), while QRISK3 and SLECRE had the lowest (0. 67). CONCLUSION mFRS was superior to FRS and was not outperformed by the QRISK tools. SLECRE had the highest sensitivity but the lowest specificity. mFRS is an SLE-adjusted practical tool with a simple, intuitive scoring system reasonably appropriate for ambulatory settings, with more research needed to develop more accurate CVD risk prediction tools in this population.
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Affiliation(s)
| | - Paula Harvey
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Ahmed Omar
- University of Toronto, Toronto, Ontario, Canada
| | - Oshrat Tayer-Shifman
- Department of Internal Medicine B and Rheumatology Service, Meir Medical Center, Kfar Saba, Israel
| | - Murray B Urowitz
- Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto Western Hospital Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada
| | - Dafna D Gladman
- University of Toronto, Toronto, Ontario, Canada.,Toronto Western Hospital Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada
| | - Nicole Anderson
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jiandong Su
- Toronto Western Hospital Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada
| | - Zahi Touma
- University of Toronto, Toronto, Ontario, Canada .,Toronto Western Hospital Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada
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18
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Tselios K, Gladman DD, Al‐Sheikh H, Su J, Urowitz MB. Medium versus high initial prednisone dose for remission induction in lupus nephritis: A propensity score matched analysis. Arthritis Care Res (Hoboken) 2021; 74:1451-1458. [DOI: 10.1002/acr.24592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/05/2021] [Accepted: 03/02/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Konstantinos Tselios
- Centre for Prognosis Studies in Rheumatic Diseases Toronto Lupus Clinic University Health Network Toronto Ontario Canada
| | - Dafna D Gladman
- Centre for Prognosis Studies in Rheumatic Diseases Toronto Lupus Clinic University Health Network Toronto Ontario Canada
| | - Haifa Al‐Sheikh
- Centre for Prognosis Studies in Rheumatic Diseases Toronto Lupus Clinic University Health Network Toronto Ontario Canada
| | - Jiandong Su
- Centre for Prognosis Studies in Rheumatic Diseases Toronto Lupus Clinic University Health Network Toronto Ontario Canada
| | - Murray B Urowitz
- Centre for Prognosis Studies in Rheumatic Diseases Toronto Lupus Clinic University Health Network Toronto Ontario Canada
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19
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Mai L, Asaduzzaman A, Noamani B, Fortin PR, Gladman DD, Touma Z, Urowitz MB, Wither J. The baseline interferon signature predicts disease severity over the subsequent 5 years in systemic lupus erythematosus. Arthritis Res Ther 2021; 23:29. [PMID: 33451338 PMCID: PMC7811214 DOI: 10.1186/s13075-021-02414-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 01/01/2021] [Indexed: 12/19/2022] Open
Abstract
Objectives Type I interferons (IFNs) play an important role in the pathophysiology of systemic lupus erythematosus (SLE). While cross-sectional data suggest an association between IFN-induced gene expression and SLE disease activity, interest in this as a biomarker of flare has been tempered by a lack of fluctuation with disease activity in the majority of patients. This led us to question whether IFN-induced gene expression might instead be a biomarker of overall disease severity, with patients with high levels spending more time in an active disease state. Methods Levels of five interferon-responsive genes were measured in the whole peripheral blood at baseline visit for 137 SLE patients subsequently followed for 5 years. Log transformed values were summed to yield a composite IFN5 score, and the correlation with various disease outcomes examined. Receiver operator characteristic analyses were performed for outcomes of interest. Kaplan-Meier curves were generated to compare the proportion of flare-free patients with high and low IFN5 scores over time. Results The baseline IFN5 score was positively correlated with the adjusted mean SLE disease activity index-2000, number of flares, adjusted mean prednisone dose, and number of new immunosuppressive medications over the subsequent 5 years. Optimal cut-offs for the IFN5 score were determined using Youden’s index and predicted more severe outcomes with 57–67% accuracy. A high baseline IFN5 level was associated with a significantly increased risk of subsequent flare. Conclusions Measurement of the type I IFN signature is a useful tool for predicting the subsequent disease activity course.
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Affiliation(s)
- Lloyd Mai
- Division of Rheumatology, Schroeder Arthritis Institute, University Health Network, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Arundip Asaduzzaman
- Division of Rheumatology, Schroeder Arthritis Institute, University Health Network, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Babak Noamani
- Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Paul R Fortin
- Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec - Université Laval, Quebec City, QC, Canada
| | - Dafna D Gladman
- Division of Rheumatology, Schroeder Arthritis Institute, University Health Network, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.,University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Zahi Touma
- Division of Rheumatology, Schroeder Arthritis Institute, University Health Network, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.,University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Murray B Urowitz
- Division of Rheumatology, Schroeder Arthritis Institute, University Health Network, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.,University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Joan Wither
- Division of Rheumatology, Schroeder Arthritis Institute, University Health Network, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada. .,Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, Canada. .,Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, Canada. .,Schroeder Arthritis Institute, Krembil Research Institute, 5KD402, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada.
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20
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Tselios K, Wakani L, Gladman DD, Su J, Urowitz MB. Response to placebo in non-renal, non-neuropsychiatric systemic lupus erythematosus: a systematic review and pooled analysis. Rheumatology (Oxford) 2021; 60:73-80. [PMID: 33140092 DOI: 10.1093/rheumatology/keaa655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Most randomized controlled trials (RCTs) in SLE have failed to reach their respective end points, with the rates of response to placebo (plus standard-of-care treatment) being unexpectedly high. The aim of this systematic review was to quantify the response to placebo in non-renal, non-neuropsychiatric lupus. METHODS The PubMed database was searched (from 2000 to December 2019) for phase II/III RCTs assessing the efficacy and safety of biologics in non-renal, non-neuropsychiatric SLE. Data on the efficacy and safety of the placebo-treated patients were collected in a pre-established data retrieval form. Descriptive statistics were used. RESULTS A total of 24 RCTs (n = 11128 in total) were included. Placebo-treated patients (n = 3899) were mostly females (93.5%), Caucasians (60.2%), of mean age 39.7 years, and having a mean disease duration of 7.4 years. Their mean initial SLEDAI 2000 was 10.4, whereas 60.5% had positive anti-dsDNA antibodies, 41.9% low C3 and 35.6% low C4 at randomization. Standard-of-care treatment included glucocorticosteroids in 85.9%, antimalarials in 72.8% and immunosuppressives in 48.5%. The response to placebo was 36.2% for the primary end point (as defined in each study), 39.8% for the SLE Responder Index-4 (SRI-4), 29.2% for SRI-5, 28.4% for SRI-6 and 30.9% for BILAG-based Combined Lupus Assessment response. Regarding safety, there were serious adverse events in 16.3% of patients, serious infections in 5.5% and malignancies in 0.3%, and death occurred in 0.56% of patients. CONCLUSION More than one-third of the placebo-treated patients achieved their respective primary end points in RCTs with biologics in non-renal, non-neuropsychiatric SLE. The response rate was higher for certain end points, such as the SRI-4, while it decreased with more stringent end points.
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Affiliation(s)
- Konstantinos Tselios
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Canada
| | - Laura Wakani
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Canada
| | - Dafna D Gladman
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Canada
| | - Jiandong Su
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Canada
| | - Murray B Urowitz
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Canada
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21
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Barber MRW, Hanly JG, Su L, Urowitz MB, St Pierre Y, Romero-Diaz J, Gordon C, Bae SC, Bernatsky S, Wallace DJ, Merrill JT, Isenberg DA, Rahman A, Ginzler EM, Petri M, Bruce IN, Dooley MA, Fortin PR, Gladman DD, Sanchez-Guerrero J, Steinsson K, Ramsey-Goldman R, Khamashta MA, Aranow C, Mackay M, Alarcón GS, Manzi S, Nived O, Jönsen A, Zoma AA, van Vollenhoven RF, Ramos-Casals M, Ruiz-Irastorza G, Lim SS, Kalunian KC, Inanc M, Kamen DL, Peschken CA, Jacobsen S, Askanase A, Farewell V, Stoll T, Buyon J, Clarke AE. Economic Evaluation of Damage Accrual in an International Systemic Lupus Erythematosus Inception Cohort Using a Multistate Model Approach. Arthritis Care Res (Hoboken) 2020; 72:1800-1808. [PMID: 31609532 DOI: 10.1002/acr.24092] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 10/08/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE There is a paucity of data regarding health care costs associated with damage accrual in systemic lupus erythematosus. The present study was undertaken to describe costs associated with damage states across the disease course using multistate modeling. METHODS Patients from 33 centers in 11 countries were enrolled in the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort within 15 months of diagnosis. Annual data on demographics, disease activity, damage (SLICC/American College of Rheumatology Damage Index [SDI]), hospitalizations, medications, dialysis, and selected procedures were collected. Ten-year cumulative costs (Canadian dollars) were estimated by multiplying annual costs associated with each SDI state by the expected state duration using a multistate model. RESULTS A total of 1,687 patients participated; 88.7% were female, 49.0% were white, mean ± SD age at diagnosis was 34.6 ± 13.3 years, and mean time to follow-up was 8.9 years (range 0.6-18.5 years). Mean annual costs were higher for those with higher SDI scores as follows: $22,006 (Canadian) (95% confidence interval [95% CI] $16,662, $27,350) for SDI scores ≥5 versus $1,833 (95% CI $1,134, $2,532) for SDI scores of 0. Similarly, 10-year cumulative costs were higher for those with higher SDI scores at the beginning of the 10-year interval as follows: $189,073 (Canadian) (95% CI $142,318, $235,827) for SDI scores ≥5 versus $21,713 (95% CI $13,639, $29,788) for SDI scores of 0. CONCLUSION Patients with the highest SDI scores incur 10-year cumulative costs that are ~9-fold higher than those with the lowest SDI scores. By estimating the damage trajectory and incorporating annual costs, data on damage can be used to estimate future costs, which is critical knowledge for evaluating the cost-effectiveness of novel therapies.
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Affiliation(s)
| | - John G Hanly
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Li Su
- University of Cambridge, Cambridge, UK
| | - Murray B Urowitz
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Yvan St Pierre
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | | | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | | | - Daniel J Wallace
- Cedars-Sinai Medical Center and University of California, Los Angeles
| | | | | | | | - Ellen M Ginzler
- State University of New York Downstate Medical Center, Brooklyn
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ian N Bruce
- Manchester Academic Health Sciences Centre, University of Manchester and Central Manchester University Hospitals National Health Service Foundation Trust, Manchester, UK
| | | | - Paul R Fortin
- CHU de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Dafna D Gladman
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | - Cynthia Aranow
- Feinstein Institutes for Medical Research, Manhasset, New York
| | - Meggan Mackay
- Feinstein Institutes for Medical Research, Manhasset, New York
| | | | - Susan Manzi
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Asad A Zoma
- Hairmyres Hospital, East Kilbride, Scotland, UK
| | | | | | | | | | | | | | | | | | - Søren Jacobsen
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anca Askanase
- Hospital for Joint Diseases, New York University Seligman Center for Advanced Therapeutics, New York, New York
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22
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Legge A, Kirkland S, Rockwood K, Andreou P, Bae SC, Gordon C, Romero-Diaz J, Sanchez-Guerrero J, Wallace DJ, Bernatsky S, Clarke AE, Merrill JT, Ginzler EM, Fortin PR, Gladman DD, Urowitz MB, Bruce IN, Isenberg DA, Rahman A, Alarcón GS, Petri M, Khamashta MA, Dooley MA, Ramsey-Goldman R, Manzi S, Zoma AA, Aranow C, Mackay M, Ruiz-Irastorza G, Lim SS, Inanc M, van Vollenhoven RF, Jonsen A, Nived O, Ramos-Casals M, Kamen DL, Kalunian KC, Jacobsen S, Peschken CA, Askanase A, Hanly JG. Prediction of hospitalizations in systemic lupus erythematosus using the Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI). Arthritis Care Res (Hoboken) 2020; 74:638-647. [PMID: 33152181 DOI: 10.1002/acr.24504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 10/22/2020] [Accepted: 11/03/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) predicts mortality and damage accrual in SLE, but its association with hospitalizations has not been described. We estimated the association of baseline SLICC-FI values with future hospitalizations in the SLICC inception cohort. METHODS Baseline SLICC-FI scores were calculated. The number and duration of inpatient hospitalizations during follow-up were recorded. Negative binomial regression was used to estimate the association between baseline SLICC-FI values and the rate of hospitalizations per patient-year of follow-up. Linear regression was used to estimate the association of baseline SLICC-FI scores with the proportion of follow-up time spent in hospital. Multivariable models were adjusted for relevant baseline characteristics. RESULTS The 1549 SLE patients eligible for this analysis were mostly female (88.7%) with mean (SD) age 35.7 (13.3) years and median (IQR) disease duration 1.2 (0.9-1.5) years at baseline. Mean (SD) baseline SLICC-FI was 0.17 (0.08). During mean (SD) follow-up of 7.2 (3.7) years, 614 patients (39.6%) experienced 1570 hospitalizations. Higher baseline SLICC-FI values (per 0.05 increment) were associated with more frequent hospitalizations during follow-up (Incidence Rate Ratio 1.21; 95%CI 1.13-1.30), adjusting for baseline age, sex, corticosteroid use, immunosuppressive use, ethnicity/location, SLE disease activity index 2000 (SLEDAI-2K), SLICC/ACR damage index (SDI), and disease duration. Among patients with ≥1 hospitalization, higher baseline SLICC-FI values predicted a greater proportion of follow-up time spent hospitalized (Relative Rate 1.09; 95%CI 1.02-1.16). CONCLUSION The SLICC-FI predicts future hospitalizations among incident SLE patients, further supporting the SLICC-FI as a valid health measure in SLE.
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Affiliation(s)
- Alexandra Legge
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan Kirkland
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Pantelis Andreou
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Daniel J Wallace
- Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ann E Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joan T Merrill
- Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Ellen M Ginzler
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Paul R Fortin
- Division of Rheumatology, CHU de Québec - Université Laval, Quebec City, Canada
| | - Dafna D Gladman
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, ON, Canada, Oakland
| | - Murray B Urowitz
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, ON, Canada, Oakland
| | - Ian N Bruce
- Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center Manchester, UK
| | - David A Isenberg
- Center for Rheumatology, Department of Medicine, University College London, UK, London
| | - Anisur Rahman
- Center for Rheumatology, Department of Medicine, University College London, UK, London
| | - Graciela S Alarcón
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Munther A Khamashta
- Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK
| | - M A Dooley
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA, Chapel Hill
| | | | - Susan Manzi
- Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, PA, USA
| | - Asad A Zoma
- Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK
| | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Meggan Mackay
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - S Sam Lim
- Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia, USA
| | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | | | - Andreas Jonsen
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - Ola Nived
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - Manuel Ramos-Casals
- Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
| | - Diane L Kamen
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Soren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Anca Askanase
- Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics, New York, NY, USA
| | - John G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
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Tselios K, Gladman DD, Su J, Urowitz MB. Advanced Chronic Kidney Disease in Lupus Nephritis: Is Dialysis Inevitable? J Rheumatol 2020; 47:1366-1373. [PMID: 32238519 DOI: 10.3899/jrheum.191064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Advanced chronic kidney disease (CKD) carries an increased risk for progression to endstage renal disease (ESRD). We aimed to determine the rate of progression and the factors that drive the decline of renal function in lupus nephritis (LN). METHODS Patients with advanced LN-related CKD were identified from our longterm longitudinal cohort. Advanced CKD was defined as stage 3b [estimated glomerular filtration rate (eGFR) = 30-44 ml/min/1.73 m2] and stage 4 (eGFR = 15-29 ml/min/1.73 m2). All individuals were followed until progression to ESRD or the last visit and were divided into "progressors" and "non- progressors." Demographic, clinical, immunological, and therapeutic variables were compared at baseline. Multivariable Cox regression analysis (both time-dependent and independent) was performed to identify predictors for progression. RESULTS One hundred eighteen patients (74 CKD 3b and 44 CKD 4) were included. Forty-five patients progressed (29 to ESRD and 16 from CKD 3b to CKD 4) after 6 years on average. No significant decline in the renal function was observed in 73 patients ("non-progressors") after 10 years on average. Active serology (high anti-dsDNA titers and low complements C3/C4) at the time of CKD diagnosis and any increase of the daily prednisone dose after baseline were strongly associated with progression. Treatment with renin angiotensin system (RAS) blockers was associated with less risk for progression. CONCLUSION Dialysis is not inevitable in LN-related advanced CKD because 62% of our patients did not progress over 10 years of followup on average. Certain predictors were identified to affect progression to ESRD.
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Affiliation(s)
- Konstantinos Tselios
- From the Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Ontario, Canada.,K. Tselios, MD, PhD; D.D. Gladman, MD, FRCPC; J. Su, MB, MSc; M.B. Urowitz, MD, FRCPC, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network
| | - Dafna D Gladman
- From the Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Ontario, Canada.,K. Tselios, MD, PhD; D.D. Gladman, MD, FRCPC; J. Su, MB, MSc; M.B. Urowitz, MD, FRCPC, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network
| | - Jiandong Su
- From the Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Ontario, Canada.,K. Tselios, MD, PhD; D.D. Gladman, MD, FRCPC; J. Su, MB, MSc; M.B. Urowitz, MD, FRCPC, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network
| | - Murray B Urowitz
- From the Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Ontario, Canada. .,K. Tselios, MD, PhD; D.D. Gladman, MD, FRCPC; J. Su, MB, MSc; M.B. Urowitz, MD, FRCPC, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network.
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Tselios K, Gladman DD, Taheri C, Su J, Urowitz MB. Factors Associated With Rapid Progression to Endstage Kidney Disease in Lupus Nephritis. J Rheumatol 2020; 48:228-231. [PMID: 33259331 DOI: 10.3899/jrheum.200161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Lupus nephritis (LN) may lead to endstage kidney disease (ESKD) in 22% of patients over a period of 15 years, with the risk being particularly higher in diffuse proliferative forms. The rate of kidney function decline varies. However, a catastrophic course leading to ESKD within a few years from onset is uncommon. The aim of the present study was to assess the factors associated with rapid progression to ESKD in patients with LN. METHODS Patients from the Toronto Lupus Clinic with biopsy-proven LN at presentation and estimated glomerular filtration rate (eGFR) 60 mL/min/1.73 m2, who developed ESKD within 3 years were retrieved. Pathology reports were reviewed with particular emphasis on distinct histopathologic features. Demographic, clinical, laboratory, and therapeutic variables were also analyzed. RESULTS Ten patients (1.8% of the total LN population) developed ESKD within 3 years of diagnosis. Their mean age was 34.2 ± 7.3 years, mean time to ESKD 19.2 ± 12.4 months, initial eGFR 90.2 ± 24.9 mL/min/1.73 m2, proteinuria 2.7 ± 1.04 g/24 h. The median rate of kidney function decline was > 43 mL/min/1.73 m2/year. One patient had LN class III, 5 had LN class IV, 2 had membranous LN (class V), and another 2 had mixed IV/V. Moreover, 2 patients had extensive thrombotic microangiopathy, 1 collapsing glomerulonephritis, and 1 concomitant antiglomerular basement membrane (anti-GBM) nephropathy. Four patients showed no unusual kidney pathology; all of them had severe noncompliance (discontinued all medications to follow alternative treatment). CONCLUSION Catastrophic progression to ESKD is uncommon in LN. The major associated factors are poor compliance and distinct histopathologic features such as thrombotic microangiopathy, collapsing glomerulopathy, and concomitant anti-GBM nephropathy.
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Affiliation(s)
- Konstantinos Tselios
- K. Tselios, MD, PhD, D.D. Gladman, MD, FRCPC, C. Taheri, BHSc, J. Su, MB, MSc, M.B. Urowitz, MD, FRCPC, University of Toronto Lupus Clinic, Centre of Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto, Ontario, Canada
| | - Dafna D Gladman
- K. Tselios, MD, PhD, D.D. Gladman, MD, FRCPC, C. Taheri, BHSc, J. Su, MB, MSc, M.B. Urowitz, MD, FRCPC, University of Toronto Lupus Clinic, Centre of Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto, Ontario, Canada
| | - Cameron Taheri
- K. Tselios, MD, PhD, D.D. Gladman, MD, FRCPC, C. Taheri, BHSc, J. Su, MB, MSc, M.B. Urowitz, MD, FRCPC, University of Toronto Lupus Clinic, Centre of Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto, Ontario, Canada
| | - Jiandong Su
- K. Tselios, MD, PhD, D.D. Gladman, MD, FRCPC, C. Taheri, BHSc, J. Su, MB, MSc, M.B. Urowitz, MD, FRCPC, University of Toronto Lupus Clinic, Centre of Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto, Ontario, Canada
| | - Murray B Urowitz
- K. Tselios, MD, PhD, D.D. Gladman, MD, FRCPC, C. Taheri, BHSc, J. Su, MB, MSc, M.B. Urowitz, MD, FRCPC, University of Toronto Lupus Clinic, Centre of Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto, Ontario, Canada.
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Urowitz MB, Gladman DD, Farewell V, Su J, Romero-Diaz J, Bae SC, Fortin PR, Sanchez-Guerrero J, Clarke AE, Bernatsky S, Gordon C, Hanly JG, Wallace DJ, Isenberg DA, Rahman A, Merrill JT, Ginzler E, Alarcón GS, Chatham WW, Petri MA, Bruce IN, Khamashta MA, Aranow C, Dooley MA, Manzi S, Ramsey-Goldman R, Nived O, Jönsen A, Steinsson K, Zoma AA, Ruiz-Irastorza G, Lim SS, Kalunian KC, Ỉnanç M, van Vollenhoven R, Ramos-Casals M, Kamen DL, Jacobsen S, Peschken CA, Askanase A, Stoll T. Accrual of Atherosclerotic Vascular Events in a Multicenter Inception Systemic Lupus Erythematosus Cohort. Arthritis Rheumatol 2020; 72:1734-1740. [PMID: 32515554 DOI: 10.1002/art.41392] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/13/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE In previous studies, atherosclerotic vascular events (AVEs) were shown to occur in ~10% of patients with systemic lupus erythematosus (SLE). We undertook this study to investigate the annual occurrence and potential risk factors for AVEs in a multinational, multiethnic inception cohort of patients with SLE. METHODS A large 33-center cohort of SLE patients was followed up yearly between 1999 and 2017. AVEs were attributed to atherosclerosis based on SLE being inactive at the time of the AVE as well as typical atherosclerotic changes observed on imaging or pathology reports and/or evidence of atherosclerosis elsewhere. Analyses included descriptive statistics, rate of AVEs per 1,000 patient-years, and univariable and multivariable relative risk regression models. RESULTS Of the 1,848 patients enrolled in the cohort, 1,710 had ≥1 follow-up visit after enrollment, for a total of 13,666 patient-years. Of these 1,710 patients, 3.6% had ≥1 AVEs attributed to atherosclerosis, for an event rate of 4.6 per 1,000 patient-years. In multivariable analyses, lower AVE rates were associated with antimalarial treatment (hazard ratio [HR] 0.54 [95% confidence interval (95% CI) 0.32-0.91]), while higher AVE rates were associated with any prior vascular event (HR 4.00 [95% CI 1.55-10.30]) and a body mass index of >40 kg/m2 (HR 2.74 [95% CI 1.04-7.18]). A prior AVE increased the risk of subsequent AVEs (HR 5.42 [95% CI 3.17-9.27], P < 0.001). CONCLUSION The prevalence of AVEs and the rate of AVE accrual demonstrated in the present study is much lower than that seen in previously published data. This may be related to better control of both the disease activity and classic risk factors.
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Affiliation(s)
- Murray B Urowitz
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Dafna D Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Vernon Farewell
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Jiandong Su
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, and University of Toronto, Toronto, Ontario, Canada
| | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Paul R Fortin
- Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Quebec, Canada
| | - Jorge Sanchez-Guerrero
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Ann Elaine Clarke
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sasha Bernatsky
- Montreal General Hospital and McGill University Health Centre, Montreal, Quebec, Canada
| | - Caroline Gordon
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - John G Hanly
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Daniel J Wallace
- Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California, Los Angeles
| | | | | | | | | | | | | | - Michelle A Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ian N Bruce
- Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Sciences Centre, The University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Munther A Khamashta
- St Thomas' Hospital and King's College London School of Medicine, London, UK
| | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | - Susan Manzi
- Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania
| | | | - Ola Nived
- Lund University and Skåne University Hospital, Lund, Sweden
| | - Andreas Jönsen
- Lund University and Skåne University Hospital, Lund, Sweden
| | - Kristján Steinsson
- Fossvogur Landspitali University Hospital Center for Rheumatology Research, Reykjavik, Iceland
| | - Asad A Zoma
- Hairmyres Hospital, East Kilbride, Scotland, UK
| | | | - S Sam Lim
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Murat Ỉnanç
- Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | | | - Manuel Ramos-Casals
- Institut d'Investigacions Biomèdiques August Pi i Sunyer and Hospital Clínic, Barcelona, Spain
| | | | - Soren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic and Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Anca Askanase
- Hospital for Joint Diseases, New York University, New York, New York
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Bernatsky S, Ramsey-Goldman R, Urowitz MB, Hanly JG, Gordon C, Petri MA, Ginzler EM, Wallace DJ, Bae SC, Romero-Diaz J, Dooley MA, Peschken CA, Isenberg DA, Rahman A, Manzi S, Jacobsen S, Lim SS, van Vollenhoven R, Nived O, Kamen DL, Aranow C, Ruiz-Irastorza G, Sanchez-Guerrero J, Gladman DD, Fortin PR, Alarcón GS, Merrill JT, Kalunian KC, Ramos-Casals M, Steinsson K, Zoma A, Askanase A, Khamashta MA, Bruce I, Inanc M, Clarke AE. Cancer risk in a large inception SLE cohort: Effects of demographics, smoking, and medications. Arthritis Care Res (Hoboken) 2020; 73:1789-1795. [PMID: 32813314 DOI: 10.1002/acr.24425] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 08/11/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess cancer risk factors in incident SLE. METHODS Clinical variables and cancer outcomes were assessed annually among incident SLE patients. Multivariate hazard regression models (over-all risk, and most common cancers) included demographics and time-dependent medications (corticosteroids, antimalarial drugs, immunosuppressants), smoking, and adjusted mean SLE Disease Activity Index-2K. RESULTS Among 1668 patients (average 9 years follow-up), 65 cancers occurred: 15 breast, 10 non-melanoma skin, seven lung, six hematological, six prostate, five melanoma, three cervical, three renal, two each gastric, head and neck, and thyroid, and one each rectal, sarcoma, thymoma, and uterine cancers. Half of cancers (including all lung cancers) occurred in past/current smokers, versus one-third of patients without cancer. Multivariate analyses indicated over-all cancer risk was related primarily to male sex and older age at SLE diagnosis. In addition, smoking was associated with lung cancer. For breast cancer risk, age was positively and anti-malarial drugs were negatively associated. Anti-malarial drugs and higher disease activity were also negatively associated with non-melanoma skin cancer (NMSC) risk, whereas age and cyclophosphamide were positively associated. Disease activity was associated positively with hematologic and negatively with NMSC risk. CONCLUSIONS Smoking is a key modifiable risk factor, especially for lung cancer, in SLE. Immunosuppressive medications were not clearly associated with higher risk except for cyclophosphamide and NMSC. Antimalarials were negatively associated with breast cancer and NMSC risk. SLE activity was associated positively with hematologic cancer and negatively with NMSC. Since the absolute number of cancers was small, additional follow-up will help consolidate these findings.
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Affiliation(s)
- Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, University McGill, Montreal, Quebec, Canada
| | | | - Murray B Urowitz
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada
| | - John G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Michelle A Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ellen M Ginzler
- Department of Medicine, SUNY Downstate Medical Centre, Brooklyn, NY, USA
| | - Daniel J Wallace
- Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | | | - Mary Anne Dooley
- Thurston Arthritis Research Centre, University of North Carolina, Chapel Hill, NC, USA
| | | | - David A Isenberg
- Centre for Rheumatology, Department of Medicine, University College London, London, UK
| | - Anisur Rahman
- Centre for Rheumatology, Department of Medicine, University College London, London, UK
| | - Susan Manzi
- Lupus Centre of Excellence, Allegheny Health Network, Pittsburgh, PA, USA
| | - Soren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - S Sam Lim
- Emory University, Department of Medicine, Division of Rheumatology, Atlanta, Georgia, USA
| | - Ronald van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centres, Amsterdam, Holland, Netherlands
| | - Ola Nived
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - Diane L Kamen
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Jorge Sanchez-Guerrero
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada
| | - Dafna D Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada
| | - Paul R Fortin
- Division of Rheumatology, Department of Medicine, CHU de Québec, Université Laval, Quebec City, Canada
| | - Graciela S Alarcón
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joan T Merrill
- Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | | | - Manuel Ramos-Casals
- Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
| | - Kristjan Steinsson
- Department of Rheumatology, Center for Rheumatology Research Fossvogur, Landspitali University Hospital, Reykjavik, Iceland
| | - Asad Zoma
- Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK
| | - Anca Askanase
- Department of Rheumatology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Munther A Khamashta
- Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London, UK
| | - Ian Bruce
- Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre Manchester, Manchester, UK
| | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ann E Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Almaghlouth I, Pullenayegum E, Gladman DD, Urowitz MB, Johnson SR. Propensity Score Methods in Rare Disease: A Demonstration Using Observational Data in Systemic Lupus Erythematosus. J Rheumatol 2020; 48:321-325. [DOI: 10.3899/jrheum.200254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 02/07/2023]
Abstract
Observational studies allow researchers to understand the natural history of rheumatic conditions, risk factors for disease development, and factors affecting important disease-related outcomes, and to estimate treatment effect from real-world data. However, this design carries a risk of confounding bias. A propensity score (PS) is a balancing score that aims to minimize the difference between study groups and consequently potential confounding effects. The score can be applied in 1 of 4 methods in observational research: matching, stratification, adjustment, and inverse probability weighting. Systemic lupus erythematosus (SLE) is a rare disease characterized by a relatively small sample size and/or low event rates. In this article, we review the PS methods. We demonstrate application of the PS methods to achieve study group balance in a rare disease using an example of risk of infection in SLE patients with hypogammaglobulinemia.
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Webber D, Cao J, Dominguez D, Gladman DD, Levy DM, Ng L, Paterson AD, Touma Z, Urowitz MB, Wither JE, Silverman ED, Hiraki LT. Association of systemic lupus erythematosus (SLE) genetic susceptibility loci with lupus nephritis in childhood-onset and adult-onset SLE. Rheumatology (Oxford) 2020; 59:90-98. [PMID: 31236574 DOI: 10.1093/rheumatology/kez220] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/08/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE LN is one of the most common and severe manifestations of SLE. Our aim was to test the association of SLE risk loci with LN risk in childhood-onset SLE (cSLE) and adult-onset SLE (aSLE). METHODS Two Toronto-based tertiary care SLE cohorts included cSLE (diagnosed <18 years) and aSLE patients (diagnosed ⩾18 years). Patients met ACR and/or SLICC SLE criteria and were genotyped on the Illumina Multi-Ethnic Global Array or Omni1-Quad arrays. We identified those with and without biopsy-confirmed LN. HLA and non-HLA additive SLE risk-weighted genetic risk scores (GRSs) were tested for association with LN risk in logistic models, stratified by cSLE/aSLE and ancestry. Stratified effect estimates were meta-analysed. RESULTS Of 1237 participants, 572 had cSLE (41% with LN) and 665 had aSLE (30% with LN). Increasing non-HLA GRS was significantly associated with increased LN risk [odds ratio (OR) = 1.26; 95% CI 1.09, 1.46; P = 0.0006], as was increasing HLA GRS in Europeans (OR = 1.55; 95% CI 1.07, 2.25; P = 0.03). There was a trend for stronger associations between both GRSs and LN risk in Europeans with cSLE compared with aSLE. When restricting cases to proliferative LN, the magnitude of these associations increased for both the non-HLA (OR = 1.30; 95% CI 1.10, 1.52; P = 0.002) and HLA GRS (OR = 1.99; 95% CI 1.29, 3.08; P = 0.002). CONCLUSION We observed an association between known SLE risk loci and LN risk in children and adults with SLE, with the strongest effect observed among Europeans with cSLE. Future studies will include SLE-risk single nucleotide polymorphisms specific to non-European ancestral groups and validate findings in an independent cohort.
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Affiliation(s)
- Declan Webber
- Division of Rheumatology, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Jingjing Cao
- Genetics & Genome Biology, Research Institute, SickKids Hospital, Toronto, Canada
| | - Daniela Dominguez
- Division of Rheumatology, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Dafna D Gladman
- Krembil Research Institute, Toronto Western Hospital, Toronto, Canada
| | - Deborah M Levy
- Division of Rheumatology, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Lawrence Ng
- Division of Rheumatology, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Andrew D Paterson
- Genetics & Genome Biology, Research Institute, SickKids Hospital, Toronto, Canada
| | - Zahi Touma
- Krembil Research Institute, Toronto Western Hospital, Toronto, Canada
| | - Murray B Urowitz
- Krembil Research Institute, Toronto Western Hospital, Toronto, Canada
| | - Joan E Wither
- Krembil Research Institute, Toronto Western Hospital, Toronto, Canada
| | - Earl D Silverman
- Division of Rheumatology, Department of Pediatrics, University of Toronto, Toronto, Canada.,Division of Translational Medicine Research Institute, Toronto, Canada
| | - Linda T Hiraki
- Division of Rheumatology, Department of Pediatrics, University of Toronto, Toronto, Canada.,Child Health Evaluative Sciences, Research Institute, SickKids Hospital, Toronto, Canada
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Urowitz MB, Gladman DD, Ibañez D, Su J, Mursleen S, Sayani A, Ross Terres JA, Iczkovitz S. Effect of Disease Activity on Organ Damage Progression in Systemic Lupus Erythematosus: University of Toronto Lupus Clinic Cohort. J Rheumatol 2020; 48:67-73. [DOI: 10.3899/jrheum.190259] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 11/22/2022]
Abstract
Objective.To examine the role of disease activity on organ damage over 5 years in patients with active systemic lupus erythematosus (SLE) despite standard of care.Methods.This analysis of the University of Toronto Lupus Clinic cohort assessed organ damage [measured by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)] in patients with active SLE [SLE Disease Activity Index 2000 (SLEDAI-2K) ≥ 6], using Cox proportional time-independent hazard models. Subgroup analyses were conducted in patients with SLEDAI-2K 6 or 7, 8 or 9, and ≥ 10 at baseline, and in the overall study population by steroid dose at study entry (< 7.5 vs ≥ 7.5 mg/day).Results.Among the overall study population (n = 649), SDI progression was observed in 209 (32.2%) patients over the 5-year follow-up period. Mean SDI change in patients with a score > 0 was generally consistent across all SLEDAI-2K subgroups. Multivariable analyses identified age at study start (HR 1.03, P < 0.0001), steroid dose (HR 2.03, P < 0.0001), immunosuppressants (HR 1.44, P = 0.021), and SLEDAI-2K (subgroup analyses HR 1.64–2.03, P = 0.0017 to < 0.0001) as the greatest risk factors for SDI progression, while a study start date after the year 2000 had a protective effect on SDI progression compared with a start date prior to the year 2000 (HR 0.65, P = 0.0004).Conclusion.Patients within the higher SLEDAI-2K subgroups at study entry or receiving high doses of steroids were more likely to have organ damage progression.
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Legge A, Kirkland S, Rockwood K, Andreou P, Bae SC, Gordon C, Romero-Diaz J, Sanchez-Guerrero J, Wallace DJ, Bernatsky S, Clarke AE, Merrill JT, Ginzler EM, Fortin PR, Gladman DD, Urowitz MB, Bruce IN, Isenberg DA, Rahman A, Alarcón GS, Petri M, Khamashta MA, Dooley MA, Ramsey-Goldman R, Manzi S, Zoma AA, Aranow C, Mackay M, Ruiz-Irastorza G, Lim SS, Inanc M, van Vollenhoven RF, Jonsen A, Nived O, Ramos-Casals M, Kamen DL, Kalunian KC, Jacobsen S, Peschken CA, Askanase A, Hanly JG. Prediction of Damage Accrual in Systemic Lupus Erythematosus Using the Systemic Lupus International Collaborating Clinics Frailty Index. Arthritis Rheumatol 2020; 72:658-666. [PMID: 31631584 DOI: 10.1002/art.41144] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/15/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) has been shown to predict mortality, but its association with other important outcomes is unknown. We examined the association of baseline SLICC FI values with damage accrual in the SLICC inception cohort. METHODS The baseline visit was defined as the first visit at which both organ damage (SLICC/American College of Rheumatology Damage Index [SDI]) and health-related quality of life (Short Form 36) were assessed. Baseline SLICC FI scores were calculated. Damage accrual was measured by the increase in SDI between the baseline assessment and the last study visit. Multivariable negative binomial regression was used to estimate the association between baseline SLICC FI values and the rate of increase in the SDI during follow-up, adjusting for relevant demographic and clinical characteristics. RESULTS The 1,549 systemic lupus erythematosus (SLE) patients eligible for this analysis were mostly female (88.7%) with a mean ± SD age of 35.7 ± 13.3 years and a median disease duration of 1.2 years (interquartile range 0.9-1.5 years) at baseline. The mean ± SD baseline SLICC FI was 0.17 ± 0.08. Over a mean ± SD follow-up of 7.2 ± 3.7 years, 653 patients (42.2%) had an increase in SDI. Higher baseline SLICC FI values (per 0.05 increase) were associated with higher rates of increase in the SDI during follow-up (incidence rate ratio [IRR] 1.19 [95% confidence interval 1.13-1.25]), after adjusting for age, sex, ethnicity/region, education, baseline SLE Disease Activity Index 2000, baseline SDI, and baseline use of glucocorticoids, antimalarials, and immunosuppressive agents. CONCLUSION Our findings indicate that the SLICC FI predicts damage accrual in incident SLE, which further supports the SLICC FI as a valid health measure in SLE.
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Affiliation(s)
| | | | | | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Caroline Gordon
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Juanita Romero-Diaz
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Jorge Sanchez-Guerrero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Daniel J Wallace
- Cedars-Sinai Medical Center and David Geffen School of Medicine at University of California, Los Angeles
| | | | - Ann E Clarke
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | | | - Paul R Fortin
- CHU de Quebec-Université Laval, Quebec City, Quebec, Canada
| | - Dafna D Gladman
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Murray B Urowitz
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ian N Bruce
- Arthritis Research UK Epidemiology Unit, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Centre, and Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | | | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Munther A Khamashta
- St. Thomas Hospital and King's College London GKT School of Medical Education, London, UK
| | - M A Dooley
- University of North Carolina at Chapel Hill
| | | | - Susan Manzi
- Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania
| | | | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | - Meggan Mackay
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | - S Sam Lim
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | - Manuel Ramos-Casals
- Institut d'Investigacions Biomèdiques August Pi i Sunyer and Hospital Clínic, Barcelona, Barcelona, Spain
| | | | | | - Soren Jacobsen
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Anca Askanase
- Hospital for Joint Diseases, New York University New York, New York
| | - John G Hanly
- Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
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Hanly JG, Urowitz MB, Gordon C, Bae SC, Romero-Diaz J, Sanchez-Guerrero J, Bernatsky S, Clarke AE, Wallace DJ, Isenberg DA, Rahman A, Merrill JT, Fortin PR, Gladman DD, Bruce IN, Petri M, Ginzler EM, Dooley MA, Ramsey-Goldman R, Manzi S, Jönsen A, Alarcón GS, van Vollenhoven RF, Aranow C, Mackay M, Ruiz-Irastorza G, Lim S, Inanc M, Kalunian KC, Jacobsen S, Peschken CA, Kamen DL, Askanase A, Farewell V. Neuropsychiatric events in systemic lupus erythematosus: a longitudinal analysis of outcomes in an international inception cohort using a multistate model approach. Ann Rheum Dis 2020; 79:356-362. [PMID: 31915121 DOI: 10.1136/annrheumdis-2019-216150] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Using a reversible multistate model, we prospectively examined neuropsychiatric (NP) events for attribution, outcome and association with health-related quality of life (HRQoL), in an international, inception cohort of systemic lupus erythematosus (SLE) patients. METHODS Annual assessments for 19 NP events attributed to SLE and non-SLE causes, physician determination of outcome and patient HRQoL (short-form (SF)-36 scores) were measured. Time-to-event analysis and multistate modelling examined the onset, recurrence and transition between NP states. RESULTS NP events occurred in 955/1827 (52.3%) patients and 592/1910 (31.0%) unique events were attributed to SLE. In the first 2 years of follow-up the relative risk (95% CI) for SLE NP events was 6.16 (4.96, 7.66) and non-SLE events was 4.66 (4.01, 5.43) compared with thereafter. Patients without SLE NP events at initial assessment had a 74% probability of being event free at 10 years. For non-SLE NP events the estimate was 48%. The majority of NP events resolved over 10 years but mortality was higher in patients with NP events attributed to SLE (16%) versus patients with no NPSLE events (6%) while the rate was comparable in patients with non-SLE NP events (7%) compared with patients with no non-SLE events (6%). Patients with NP events had lower SF-36 summary scores compared with those without NP events and resolved NP states (p<0.001). CONCLUSIONS NP events occur most frequently around the diagnosis of SLE. Although the majority of events resolve they are associated with reduced HRQoL and excess mortality. Multistate modelling is well suited for the assessment of NP events in SLE.
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Affiliation(s)
- John G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth ll Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Murray B Urowitz
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | | | - Jorge Sanchez-Guerrero
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, Department of medicine, McGill University, Montreal, Quebec, Canada
| | - Ann E Clarke
- Divisions of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Daniel J Wallace
- Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - David A Isenberg
- Centre for Rheumatology Research, Department of Medicine, University College, London, UK
| | - Anisur Rahman
- Centre for Rheumatology Research, Department of Medicine, University College, London, UK
| | - Joan T Merrill
- Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Paul R Fortin
- Division of Rheumatology, Department of Medicine, CHU de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Dafna D Gladman
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ian N Bruce
- Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Michelle Petri
- Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ellen M Ginzler
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Mary Anne Dooley
- Thurston Arthritis Research Centre, University of North Carolina, Chapel Hill, NC, USA
| | | | - Susan Manzi
- Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, PA, USA
| | - Andreas Jönsen
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - Graciela S Alarcón
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ronald F van Vollenhoven
- Department of Rheumatology and Clinical Immunology, University Medical Centres, Amsterdam, The Netherlands
| | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Meggan Mackay
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Sam Lim
- Emory University, Department of Medicine, Division of Rheumatology, Atlanta, Georgia, USA
| | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | | | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Diane L Kamen
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Anca Askanase
- Hospital for Joint Diseases, NYU, Seligman Centre for Advanced Therapeutics, New York, NY, USA
| | - Vernon Farewell
- MRC Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
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Hanly JG, Li Q, Su L, Urowitz MB, Gordon C, Bae SC, Romero-Diaz J, Sanchez-Guerrero J, Bernatsky S, Clarke AE, Wallace DJ, Isenberg DA, Rahman A, Merrill JT, Fortin PR, Gladman DD, Bruce IN, Petri M, Ginzler EM, Dooley MA, Steinsson K, Ramsey-Goldman R, Zoma AA, Manzi S, Nived O, Jonsen A, Khamashta MA, Alarcón GS, Svenungsson E, van Vollenhoven RF, Aranow C, Mackay M, Ruiz-Irastorza G, Ramos-Casals M, Lim SS, Inanc M, Kalunian KC, Jacobsen S, Peschken CA, Kamen DL, Askanase A, Theriault C, Farewell V. Peripheral Nervous System Disease in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. Arthritis Rheumatol 2020; 72:67-77. [PMID: 31390162 PMCID: PMC6935421 DOI: 10.1002/art.41070] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 08/01/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the frequency, clinical characteristics, associations, and outcomes of different types of peripheral nervous system (PNS) disease in a multiethnic/multiracial, prospective inception cohort of systemic lupus erythematosus (SLE) patients. METHODS Patients were evaluated annually for 19 neuropsychiatric (NP) events including 7 types of PNS disease. SLE disease activity, organ damage, autoantibodies, and patient and physician assessment of outcome were measured. Time to event and linear regressions were used as appropriate. RESULTS Of 1,827 SLE patients, 88.8% were female, and 48.8% were white. The mean ± SD age was 35.1 ± 13.3 years, disease duration at enrollment was 5.6 ± 4.2 months, and follow-up was 7.6 ± 4.6 years. There were 161 PNS events in 139 (7.6%) of 1,827 patients. The predominant events were peripheral neuropathy (66 of 161 [41.0%]), mononeuropathy (44 of 161 [27.3%]), and cranial neuropathy (39 of 161 [24.2%]), and the majority were attributed to SLE. Multivariate Cox regressions suggested longer time to resolution in patients with a history of neuropathy, older age at SLE diagnosis, higher SLE Disease Activity Index 2000 scores, and for peripheral neuropathy versus other neuropathies. Neuropathy was associated with significantly lower Short Form 36 (SF-36) physical and mental component summary scores versus no NP events. According to physician assessment, the majority of neuropathies resolved or improved over time, which was associated with improvements in SF-36 summary scores for peripheral neuropathy and mononeuropathy. CONCLUSION PNS disease is an important component of total NPSLE and has a significant negative impact on health-related quality of life. The outcome is favorable for most patients, but our findings indicate that several factors are associated with longer time to resolution.
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Affiliation(s)
- John G Hanly
- Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Qiuju Li
- University of Cambridge, Cambridge, UK
| | - Li Su
- University of Cambridge, Cambridge, UK
| | - Murray B Urowitz
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Caroline Gordon
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | | | | | | | - Ann E Clarke
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Daniel J Wallace
- Cedars-Sinai and University of California, Los Angeles School of Medicine
| | | | | | | | - Paul R Fortin
- CHU de Québec and Université Laval, Québec City, Québec, Canada
| | - Dafna D Gladman
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ian N Bruce
- Arthritis Research UK Epidemiology Unit, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Centre, and Manchester University NHS Foundation Trust, Manchester, UK
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - M A Dooley
- University of North Carolina, Chapel Hill, North Carolina
| | | | | | | | - Susan Manzi
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | | | | | - Munther A Khamashta
- St. Thomas' Hospital and King's College London School of Medicine, London, UK
| | | | | | | | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | - Meggan Mackay
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | - Manuel Ramos-Casals
- Institut d'Investigacions Biomèdiques August Pi i Sunyer and Hospital Clínic de Barcelona, Barcelona, Spain
| | - S Sam Lim
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Soren Jacobsen
- Rigshospitalet and Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | - Chris Theriault
- Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
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Hanneman K, Alberdi HV, Karur GR, Tselios K, Harvey PJ, Gladman DD, Akhtari S, Osuntokun T, Wald RM, Thavendiranathan P, Butany J, Urowitz MB. Antimalarial-Induced Cardiomyopathy Resembles Fabry Disease on Cardiac MRI. JACC Cardiovasc Imaging 2019; 13:879-881. [PMID: 31734202 DOI: 10.1016/j.jcmg.2019.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
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Tselios K, Gladman DD, Harvey P, Akhtari S, Su J, Urowitz MB. Dr. Tselios, et al, reply. J Rheumatol 2019; 46:1422. [PMID: 31263072 DOI: 10.3899/jrheum.190255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Konstantinos Tselios
- Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, University Health Network
| | - Dafna D Gladman
- Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, University Health Network
| | - Paula Harvey
- Cardiology Department, Women's College Hospital, University of Toronto
| | - Shadi Akhtari
- Cardiology Department, Women's College Hospital, University of Toronto
| | - Jiandong Su
- Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, University Health Network
| | - Murray B Urowitz
- Toronto Lupus Clinic, Centre for Prognosis Studies in Rheumatic Diseases, University Health Network, Toronto, Ontario, Canada.
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35
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Mendel A, Bernatsky S, Pineau CA, St-Pierre Y, Hanly JG, Urowitz MB, Clarke AE, Romero-Diaz J, Gordon C, Bae SC, Wallace DJ, Merrill JT, Buyon J, Isenberg DA, Rahman A, Ginzler EM, Petri M, Dooley MA, Fortin P, Gladman DD, Steinsson K, Ramsey-Goldman R, Khamashta MA, Aranow C, Mackay M, Alarcón G, Manzi S, Nived O, Jönsen A, Zoma AA, van Vollenhoven RF, Ramos-Casals M, Ruiz-Irastorza G, Lim S, Kalunian KC, Inanc M, Kamen DL, Peschken CA, Jacobsen S, Askanase A, Sanchez-Guerrero J, Bruce IN, Costedoat-Chalumeau N, Vinet E. Use of combined hormonal contraceptives among women with systemic lupus erythematosus with and without medical contraindications to oestrogen. Rheumatology (Oxford) 2019; 58:1259-1267. [PMID: 30753683 PMCID: PMC6821299 DOI: 10.1093/rheumatology/kez014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/26/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the prevalence of combined hormonal contraceptives (CHCs) in reproductive-age women with SLE with and without possible contraindications and to determine factors associated with their use in the presence of possible contraindications. METHODS This observational cohort study included premenopausal women ages 18-45 years enrolled in the SLICC Registry ⩽15 months after SLE onset, with annual assessments spanning 2000-2017. World Health Organization Category 3 or 4 contraindications to CHCs (e.g. hypertension, aPL) were assessed at each study visit. High disease activity (SLEDAI score >12 or use of >0.5 mg/kg/day of prednisone) was considered a relative contraindication. RESULTS A total of 927 SLE women contributed 6315 visits, of which 3811 (60%) occurred in the presence of one or more possible contraindication to CHCs. Women used CHCs during 512 (8%) visits, of which 281 (55%) took place in the setting of one or more possible contraindication. The most frequently observed contraindications were aPL (52%), hypertension (34%) and migraine with aura (22%). Women with one or more contraindication were slightly less likely to be taking CHCs [7% of visits (95% CI 7, 8)] than women with no contraindications [9% (95% CI 8, 10)]. CONCLUSION CHC use was low compared with general population estimates (>35%) and more than half of CHC users had at least one possible contraindication. Many yet unmeasured factors, including patient preferences, may have contributed to these observations. Further work should also aim to clarify outcomes associated with this exposure.
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Affiliation(s)
- Arielle Mendel
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sasha Bernatsky
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - Christian A Pineau
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yvan St-Pierre
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - John G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Murray B Urowitz
- Centre for Prognosis Studies in the Rheumatic Disease and Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ann E Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Juanita Romero-Diaz
- Division of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Rheumatology Department, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Daniel J Wallace
- Cedars-Sinai Medical Centre, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joan T Merrill
- Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Jill Buyon
- Division of Rheumatology, Department of Medicine, New York School of Medicine, New York, NY, USA
| | - David A Isenberg
- Centre for Rheumatology, Department of Medicine, University College London, London, UK
| | - Anisur Rahman
- Centre for Rheumatology, Department of Medicine, University College London, London, UK
| | - Ellen M Ginzler
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Anne Dooley
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Paul Fortin
- Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Québec City, Quebec, Canada
| | - Dafna D Gladman
- Centre for Prognosis Studies in the Rheumatic Disease and Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kristján Steinsson
- Center for Rheumatology Research, Landspitali University hospital, Reykjavik, Iceland
| | - Rosalind Ramsey-Goldman
- Division of Rheumatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Munther A Khamashta
- Lupus Research Unit, Rayne Institute, St Thomas’ Hospital, King’s College London School of Medicine, London, UK
| | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Meggan Mackay
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Graciela Alarcón
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Susan Manzi
- Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, PA, USA
| | - Ola Nived
- Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
| | - Andreas Jönsen
- Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
| | - Asad A Zoma
- Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK
| | | | - Manuel Ramos-Casals
- Joseph Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
| | - Giuillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Sam Lim
- Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Kenneth C Kalunian
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Diane L Kamen
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | | | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Section 4242, Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anca Askanase
- Division of Rheumatology, Columbia University Medical Center, New York, NY, USA
| | - Jorge Sanchez-Guerrero
- Department of Rheumatology, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ian N Bruce
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal and Dermatological Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Nathalie Costedoat-Chalumeau
- Centre de Reference Maladies Auto-immunes et Systemiques Rares, Service de Medecine Interne, Hospital Cochin, Paris, France
| | - Evelyne Vinet
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
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Choi MY, Clarke AE, St Pierre Y, Hanly JG, Urowitz MB, Romero-Diaz J, Gordon C, Bae SC, Bernatsky S, Wallace DJ, Merrill JT, Isenberg DA, Rahman A, Ginzler EM, Petri M, Bruce IN, Dooley MA, Fortin PR, Gladman DD, Sanchez-Guerrero J, Steinsson K, Ramsey-Goldman R, Khamashta MA, Aranow C, Alarcón GS, Manzi S, Nived O, Zoma AA, van Vollenhoven RF, Ramos-Casals M, Ruiz-Irastorza G, Lim SS, Kalunian KC, Inanc M, Kamen DL, Peschken CA, Jacobsen S, Askanase A, Stoll T, Buyon J, Mahler M, Fritzler MJ. Antinuclear Antibody-Negative Systemic Lupus Erythematosus in an International Inception Cohort. Arthritis Care Res (Hoboken) 2019; 71:893-902. [PMID: 30044551 DOI: 10.1002/acr.23712] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 07/17/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The spectrum of antinuclear antibodies (ANAs) is changing to include both nuclear staining as well as cytoplasmic and mitotic cell patterns (CMPs) and accordingly a change is occurring in terminology to anticellular antibodies. This study examined the prevalence of indirect immunofluorescence (IIF) anticellular antibody staining using the Systemic Lupus International Collaborating Clinics inception cohort. METHODS Anticellular antibodies were detected by IIF on HEp-2000 substrate using the baseline serum. Three serologic subsets were examined: ANA positive (presence of either nuclear or mixed nuclear/CMP staining), anticellular antibody negative (absence of any intracellular staining), and isolated CMP staining. The odds of being anticellular antibody negative versus ANA or isolated CMP positive was assessed by multivariable analysis. RESULTS A total of 1,137 patients were included; 1,049 (92.3%) were ANA positive, 71 (6.2%) were anticellular antibody negative, and 17 (1.5%) had an isolated CMP. The isolated CMP-positive group did not differ from the ANA-positive or anticellular antibody-negative groups in clinical, demographic, or serologic features. Patients who were older (odds ratio [OR] 1.02 [95% confidence interval (95% CI) 1.00, 1.04]), of white race/ethnicity (OR 3.53 [95% CI 1.77, 7.03]), or receiving high-dose glucocorticoids at or prior to enrollment (OR 2.39 [95% CI 1.39, 4.12]) were more likely to be anticellular antibody negative. Patients on immunosuppressants (OR 0.35 [95% CI 0.19, 0.64]) or with anti-SSA/Ro 60 (OR 0.41 [95% CI 0.23, 0.74]) or anti-U1 RNP (OR 0.43 [95% CI 0.20, 0.93]) were less likely to be anticellular antibody negative. CONCLUSION In newly diagnosed systemic lupus erythematosus, 6.2% of patients were anticellular antibody negative, and 1.5% had an isolated CMP. The prevalence of anticellular antibody-negative systemic lupus erythematosus will likely decrease as emerging nomenclature guidelines recommend that non-nuclear patterns should also be reported as a positive ANA.
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Affiliation(s)
- May Y Choi
- University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Ann E Clarke
- University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Yvan St Pierre
- McGill University Health Centre, Montreal, Quebec, Canada
| | - John G Hanly
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Murray B Urowitz
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | | | - Daniel J Wallace
- Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles
| | | | | | | | - Ellen M Ginzler
- State University of New York Downstate Medical Center, Brooklyn
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ian N Bruce
- Arthritis Research UK, University of Manchester, NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, and Manchester Academic Health Science Centre, Manchester, UK
| | | | - Paul R Fortin
- CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Dafna D Gladman
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jorge Sanchez-Guerrero
- Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Munther A Khamashta
- St Thomas' Hospital and King's College, London School of Medicine, London, UK
| | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | - Susan Manzi
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Ola Nived
- University Hospital Lund, Lund, Sweden
| | - Asad A Zoma
- Hairmyres Hospital, East Kilbride, Scotland, UK
| | | | | | | | - S Sam Lim
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | - Soren Jacobsen
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anca Askanase
- Hospital for Joint Diseases and New York University, New York
| | | | - Jill Buyon
- New York University School of Medicine, New York
| | | | - Marvin J Fritzler
- University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
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Legge A, Kirkland S, Rockwood K, Andreou P, Bae SC, Gordon C, Romero-Diaz J, Sanchez-Guerrero J, Wallace DJ, Bernatsky S, Clarke AE, Merrill JT, Ginzler EM, Fortin P, Gladman DD, Urowitz MB, Bruce IN, Isenberg DA, Rahman A, Alarcón GS, Petri M, Khamashta MA, Dooley MA, Ramsey-Goldman R, Manzi S, Steinsson K, Zoma AA, Aranow C, Mackay M, Ruiz-Irastorza G, Lim SS, Inanc M, van Vollenhoven RF, Jonsen A, Nived O, Ramos-Casals M, Kamen DL, Kalunian KC, Jacobsen S, Peschken CA, Askanase A, Hanly JG. Evaluating the Properties of a Frailty Index and Its Association With Mortality Risk Among Patients With Systemic Lupus Erythematosus. Arthritis Rheumatol 2019; 71:1297-1307. [PMID: 30771242 DOI: 10.1002/art.40859] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/12/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the properties of a frailty index (FI), constructed using data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort, as a novel health measure in systemic lupus erythematosus (SLE). METHODS For this secondary analysis, the baseline visit was defined as the first study visit at which both organ damage (SLICC/American College of Rheumatology Damage Index [SDI]) and health-related quality of life (Short-Form 36 [SF-36] scores) were assessed. The SLICC-FI was constructed using baseline data. The SLICC-FI comprises 48 health deficits, including items related to organ damage, disease activity, comorbidities, and functional status. Content, construct, and criterion validity of the SLICC-FI were assessed. Multivariable Cox regression was used to estimate the association between baseline SLICC-FI values and mortality risk, adjusting for demographic and clinical factors. RESULTS In the baseline data set of 1,683 patients with SLE, 89% were female, the mean ± SD age was 35.7 ± 13.4 years, and the mean ± SD disease duration was 18.8 ± 15.7 months. At baseline, the mean ± SD SLICC-FI score was 0.17 ± 0.08 (range 0-0.51). Baseline SLICC-FI values exhibited the expected measurement properties and were weakly correlated with baseline SDI scores (r = 0.26, P < 0.0001). Higher baseline SLICC-FI values (per 0.05 increment) were associated with increased mortality risk (hazard ratio 1.59, 95% confidence interval 1.35-1.87), after adjusting for age, sex, steroid use, ethnicity/region, and baseline SDI scores. CONCLUSION The SLICC-FI demonstrates internal validity as a health measure in SLE and might be used to predict future mortality risk. The SLICC-FI is potentially valuable for quantifying vulnerability among patients with SLE, and adds to existing prognostic scores.
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Affiliation(s)
| | | | | | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | | | | | | | - Daniel J Wallace
- Cedars-Sinai Medical Center and David Geffen School of Medicine at University of California, Los Angeles
| | | | | | | | | | - Paul Fortin
- CHU de Québec et Université Laval, Quebec City, Canada
| | - Dafna D Gladman
- Toronto Western Hospital and University of Toronto, Ontario, Canada
| | - Murray B Urowitz
- Toronto Western Hospital and University of Toronto, Ontario, Canada
| | - Ian N Bruce
- University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | | | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - M A Dooley
- University of North Carolina, Chapel Hill
| | | | - Susan Manzi
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | | | - Asad A Zoma
- Hairmyres Hospital, East Kilbride, Scotland, UK
| | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | - Meggan Mackay
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | - S Sam Lim
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | | | | | | | | | | | - Anca Askanase
- Hospital for Joint Diseases, New York University, New York
| | - John G Hanly
- Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
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Tselios K, Gladman DD, Touma Z, Su J, Anderson N, Urowitz MB. Clinical Remission and Low Disease Activity Outcomes Over 10 Years in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2019; 71:822-828. [DOI: 10.1002/acr.23720] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 07/24/2018] [Indexed: 12/28/2022]
Affiliation(s)
| | | | - Zahi Touma
- University Health Network Toronto Ontario Canada
| | - Jiandong Su
- University Health Network Toronto Ontario Canada
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Legge A, Kirkland S, Rockwood K, Andreou P, Bae SC, Gordon C, Romero-Diaz J, Sanchez-Guerrero J, Wallace DJ, Bernatsky S, Clarke AE, Merrill JT, Ginzler EM, Fortin P, Gladman DD, Urowitz MB, Bruce IN, Isenberg DA, Rahman A, Alarcón GS, Petri M, Khamashta MA, Dooley MA, Ramsey-Goldman R, Manzi S, Zoma AA, Aranow C, Mackay M, Ruiz-Irastorza G, Lim SS, Inanc M, van Vollenhoven RF, Jonsen A, Nived O, Ramos-Casals M, Kamen DL, Kalunian KC, Jacobsen S, Peschken CA, Askanase A, Hanly JG. Construction of a Frailty Index as a Novel Health Measure in Systemic Lupus Erythematosus. J Rheumatol 2019; 47:72-81. [PMID: 30988130 DOI: 10.3899/jrheum.181338] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To construct a Frailty Index (FI) as a measure of vulnerability to adverse outcomes among patients with systemic lupus erythematosus (SLE), using data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. METHODS The SLICC inception cohort consists of recently diagnosed patients with SLE followed annually with clinical and laboratory assessments. For this analysis, the baseline visit was defined as the first study visit at which sufficient information was available for construction of an FI. Following a standard procedure, variables from the SLICC database were evaluated as potential health deficits. Selected health deficits were then used to generate a SLICC-FI. The prevalence of frailty in the baseline dataset was evaluated using established cutpoints for FI values. RESULTS The 1683 patients with SLE (92.1% of the overall cohort) eligible for inclusion in the baseline dataset were mostly female (89%) with mean (SD) age 35.7 (13.4) years and mean (SD) disease duration 18.8 (15.7) months at baseline. Of 222 variables, 48 met criteria for inclusion in the SLICC-FI. Mean (SD) SLICC-FI was 0.17 (0.08) with a range from 0 to 0.51. At baseline, 27.1% (95% CI 25.0-29.2) of patients were classified as frail, based on SLICC-FI values > 0.21. CONCLUSION The SLICC inception cohort permits feasible construction of an FI for use in patients with SLE. Even in a relatively young cohort of patients with SLE, frailty was common. The SLICC-FI may be a useful tool for identifying patients with SLE who are most vulnerable to adverse outcomes, but validation of this index is required prior to its use.
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Affiliation(s)
- Alexandra Legge
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Susan Kirkland
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Kenneth Rockwood
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Pantelis Andreou
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Sang-Cheol Bae
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Caroline Gordon
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Juanita Romero-Diaz
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Jorge Sanchez-Guerrero
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Daniel J Wallace
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Sasha Bernatsky
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Ann E Clarke
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Joan T Merrill
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Ellen M Ginzler
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Paul Fortin
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Dafna D Gladman
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Murray B Urowitz
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Ian N Bruce
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - David A Isenberg
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Anisur Rahman
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Graciela S Alarcón
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Michelle Petri
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Munther A Khamashta
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - M A Dooley
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Rosalind Ramsey-Goldman
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Susan Manzi
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Asad A Zoma
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Cynthia Aranow
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Meggan Mackay
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Guillermo Ruiz-Irastorza
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - S Sam Lim
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Murat Inanc
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Ronald F van Vollenhoven
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Andreas Jonsen
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Ola Nived
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Manuel Ramos-Casals
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Diane L Kamen
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Kenneth C Kalunian
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Soren Jacobsen
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Christine A Peschken
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Anca Askanase
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - John G Hanly
- From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. .,A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University.
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Abstract
OBJECTIVE Atherosclerotic vascular events (AVE) are a major cause of mortality and morbidity in systemic lupus erythematosus (SLE). We aimed to determine the effect of early recognition and therapy for both classic risk factors for AVE and for SLE, on the burden of AVE in SLE in recent decades. METHODS Inception patients who entered the University of Toronto Lupus Clinic between 1975 and 1987 followed to 1992 (Cohort 1), and between 1999 and 2011 followed to 2016 (Cohort 2) were studied. AVE attributed to atherosclerosis and occurring during the 17 years were identified. SLE disease activity and therapy as well as hypertension, hypercholesterolemia, hyperglycemia, and smoking were assessed. Analysis included descriptive statistics on baseline characteristics, traditional risk factors over the followup, outcome rates by each 100 person-years (PY), Kaplan-Meier cumulative AVE curves, as well as competing risk Cox models adjusted by inverse probability weights. RESULTS Of the 234 patients in Cohort 1, 26 patients (11%) had an AVE compared with 10 of 262 patients (3.8%) in Cohort 2. The rate per 100 PY of followup was 1.8 in Cohort 1 and 0.44 in Cohort 2 (p < 0.0001). Better control of all risk factors and disease activity was achieved in Cohort 2. There was a reduction of 60% in the risk for AVE in Cohort 2. CONCLUSION The incidence of AVE in SLE in the modern era has declined in large part owing to more effective management of classic coronary artery risk factors and of SLE.
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Affiliation(s)
- Murray B Urowitz
- From the University of Toronto Lupus Clinic, Centre for Prognosis Studies in The Rheumatic Disease, Toronto Western Hospital, Toronto, Ontario, Canada. .,M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Krembil Research Institute, and Director, Centre for Prognosis Studies in The Rheumatic Disease and University of Toronto Lupus Clinic, Toronto Western Hospital; J. Su, MB, BSc, Biostatistician, Centre for Prognosis Studies in The Rheumatic Diseases, University of Toronto Lupus Clinic; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Deputy Director, Centre for Prognosis Studies in The Rheumatic Disease and University of Toronto Lupus Clinic, Toronto Western Hospital.
| | - Jiandong Su
- From the University of Toronto Lupus Clinic, Centre for Prognosis Studies in The Rheumatic Disease, Toronto Western Hospital, Toronto, Ontario, Canada.,M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Krembil Research Institute, and Director, Centre for Prognosis Studies in The Rheumatic Disease and University of Toronto Lupus Clinic, Toronto Western Hospital; J. Su, MB, BSc, Biostatistician, Centre for Prognosis Studies in The Rheumatic Diseases, University of Toronto Lupus Clinic; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Deputy Director, Centre for Prognosis Studies in The Rheumatic Disease and University of Toronto Lupus Clinic, Toronto Western Hospital
| | - Dafna D Gladman
- From the University of Toronto Lupus Clinic, Centre for Prognosis Studies in The Rheumatic Disease, Toronto Western Hospital, Toronto, Ontario, Canada.,M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Krembil Research Institute, and Director, Centre for Prognosis Studies in The Rheumatic Disease and University of Toronto Lupus Clinic, Toronto Western Hospital; J. Su, MB, BSc, Biostatistician, Centre for Prognosis Studies in The Rheumatic Diseases, University of Toronto Lupus Clinic; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Deputy Director, Centre for Prognosis Studies in The Rheumatic Disease and University of Toronto Lupus Clinic, Toronto Western Hospital
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Hanly JG, Li Q, Su L, Urowitz MB, Gordon C, Bae SC, Romero-Diaz J, Sanchez-Guerrero J, Bernatsky S, Clarke AE, Wallace DJ, Isenberg DA, Rahman A, Merrill JT, Fortin PR, Gladman DD, Bruce IN, Petri M, Ginzler EM, Dooley MA, Steinsson K, Ramsey-Goldman R, Zoma AA, Manzi S, Nived O, Jonsen A, Khamashta MA, Alarcón GS, van Vollenhoven RF, Aranow C, Mackay M, Ruiz-Irastorza G, Ramos-Casals M, Lim SS, Inanc M, Kalunian KC, Jacobsen S, Peschken CA, Kamen DL, Askanase A, Theriault C, Farewell V. Psychosis in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. Arthritis Rheumatol 2019; 71:281-289. [PMID: 30375754 PMCID: PMC6353684 DOI: 10.1002/art.40764] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/17/2018] [Indexed: 01/02/2023]
Abstract
Objective To determine, in a large, multiethnic/multiracial, prospective inception cohort of patients with systemic lupus erythematosus (SLE), the frequency, attribution, clinical, and autoantibody associations with lupus psychosis and the short‐ and long‐term outcomes as assessed by physicians and patients. Methods Patients were evaluated annually for 19 neuropsychiatric (NP) events including psychosis. Scores on the Systemic Lupus Erythematosus Disease Activity Index 2000, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, and the Short Form 36 (SF‐36) were recorded. Time to event and linear regressions were used as appropriate. Results Of 1,826 SLE patients, 88.8% were female and 48.8% were Caucasian. The mean ± SD age was 35.1 ± 13.3 years, the mean ± SD disease duration was 5.6 ± 4.2 months, and the mean ± SD follow‐up period was 7.4 ± 4.5 years. There were 31 psychotic events in 28 of 1,826 patients (1.53%), and most patients had a single event (26 of 28 [93%]). In the majority of patients (20 of 25 [80%]) and events (28 of 31 [90%]), psychosis was attributed to SLE, usually either in the year prior to or within 3 years of SLE diagnosis. Positive associations (hazard ratios [HRs] and 95% confidence intervals [95% CIs]) with lupus psychosis were previous SLE NP events (HR 3.59 [95% CI 1.16–11.14]), male sex (HR 3.0 [95% CI 1.20–7.50]), younger age at SLE diagnosis (per 10 years) (HR 1.45 [95% CI 1.01–2.07]), and African ancestry (HR 4.59 [95% CI 1.79–11.76]). By physician assessment, most psychotic events resolved by the second annual visit following onset, in parallel with an improvement in patient‐reported SF‐36 summary and subscale scores. Conclusion Psychosis is an infrequent manifestation of NPSLE. Generally, it occurs early after SLE onset and has a significant negative impact on health status. As determined by patient and physician report, the short‐ and long‐term outlooks are good for most patients, although careful follow‐up is required.
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Affiliation(s)
- John G Hanly
- Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Qiuju Li
- University of Cambridge, Cambridge, UK
| | - Li Su
- University of Cambridge, Cambridge, UK
| | - Murray B Urowitz
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | | | | | | | | | - Daniel J Wallace
- Cedars-Sinai Medical Center and David Geffen School of Medicine at University of California, Los Angeles
| | | | | | | | - Paul R Fortin
- CHU de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Dafna D Gladman
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ian N Bruce
- University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - M A Dooley
- University of North Carolina, Chapel Hill
| | | | | | - Asad A Zoma
- Hairmyres Hospital, East Kilbride, Scotland, UK
| | - Susan Manzi
- Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania
| | | | | | | | | | | | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | - Meggan Mackay
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | | | - S Sam Lim
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Soren Jacobsen
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Anca Askanase
- Hospital for Joint Diseases, New York University, New York, New York
| | - Chris Theriault
- Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
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Wirestam L, Enocsson H, Skogh T, Padyukov L, Jönsen A, Urowitz MB, Gladman DD, Romero-Diaz J, Bae SC, Fortin PR, Sanchez-Guerrero J, Clarke AE, Bernatsky S, Gordon C, Hanly JG, Wallace D, Isenberg DA, Rahman A, Merrill J, Ginzler E, Alarcón GS, Chatham WW, Petri M, Khamashta M, Aranow C, Mackay M, Dooley MA, Manzi S, Ramsey-Goldman R, Nived O, Steinsson K, Zoma A, Ruiz-Irastorza G, Lim S, Kalunian K, Inanc M, van Vollenhoven R, Ramos-Casals M, Kamen DL, Jacobsen S, Peschken C, Askanase A, Stoll T, Bruce IN, Wetterö J, Sjöwall C. Osteopontin and Disease Activity in Patients with Recent-onset Systemic Lupus Erythematosus: Results from the SLICC Inception Cohort. J Rheumatol 2019; 46:492-500. [PMID: 30647177 DOI: 10.3899/jrheum.180713] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE In cross-sectional studies, elevated osteopontin (OPN) levels have been proposed to reflect, and/or precede, progressive organ damage and disease severity in systemic lupus erythematosus (SLE). We aimed, in a cohort of patients with recent-onset SLE, to determine whether raised serum OPN levels precede damage and/or are associated with disease activity or certain disease phenotypes. METHODS We included 344 patients from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort who had 5 years of followup data available. All patients fulfilled the 1997 American College of Rheumatology (ACR) criteria. Baseline sera from patients and from age- and sex-matched population-based controls were analyzed for OPN using ELISA. Disease activity and damage were assessed at each annual followup visit using the SLE Disease Activity Index 2000 (SLEDAI-2K) and the SLICC/ACR damage index (SDI), respectively. RESULTS Compared to controls, baseline OPN was raised 4-fold in SLE cases (p < 0.0001). After relevant adjustments in a binary logistic regression model, OPN levels failed to significantly predict global damage accrual defined as SDI ≥ 1 at 5 years. However, baseline OPN correlated with SLEDAI-2K at enrollment into the cohort (r = 0.27, p < 0.0001), and patients with high disease activity (SLEDAI-2K ≥ 5) had raised serum OPN (p < 0.0001). In addition, higher OPN levels were found in patients with persistent disease activity (p = 0.0006), in cases with renal involvement (p < 0.0001) and impaired estimated glomerular filtration rate (p = 0.01). CONCLUSION The performance of OPN to predict development of organ damage was not impressive. However, OPN associated significantly with lupus nephritis and with raised disease activity at enrollment, as well as over time.
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Affiliation(s)
- Lina Wirestam
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland. .,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University.
| | - Helena Enocsson
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Thomas Skogh
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Leonid Padyukov
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Andreas Jönsen
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Murray B Urowitz
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Dafna D Gladman
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Juanita Romero-Diaz
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Sang-Cheol Bae
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Paul R Fortin
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Jorge Sanchez-Guerrero
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Ann E Clarke
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Sasha Bernatsky
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Caroline Gordon
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - John G Hanly
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Daniel Wallace
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - David A Isenberg
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Anisur Rahman
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Joan Merrill
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Ellen Ginzler
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Graciela S Alarcón
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - W Winn Chatham
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Michelle Petri
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Munther Khamashta
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Cynthia Aranow
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Meggan Mackay
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Mary Anne Dooley
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Susan Manzi
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Rosalind Ramsey-Goldman
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Ola Nived
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Kristjan Steinsson
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Asad Zoma
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Guillermo Ruiz-Irastorza
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Sam Lim
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Ken Kalunian
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Murat Inanc
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Ronald van Vollenhoven
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Manuel Ramos-Casals
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Diane L Kamen
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Søren Jacobsen
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Christine Peschken
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Anca Askanase
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Thomas Stoll
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Ian N Bruce
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Jonas Wetterö
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
| | - Christopher Sjöwall
- From the Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm; Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund; Unit for Clinical Therapy Research (ClinTRID), Karolinska University, Stockholm, Sweden; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine - University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Centre for Rheumatology Research, University College, London; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London; Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and UK National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK; Cedars-Sinai/David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Feinstein Institute for Medical Research, Manhasset, New York; Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia; University of California San Diego School of Medicine, La Jolla, California; Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina; Division of Rheumatology, Columbia University Medical Center, New York, New York, USA; Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital, Reyjkavik, Iceland; Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.,L. Wirestam, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; H. Enocsson, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; T. Skogh, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; L. Padyukov, MD, PhD, Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital; A. Jönsen, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; D.D. Gladman, MD, FRCPC, Professor of Medicine, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; J. Romero-Diaz, MD, MSc, Instituto Nacional de Ciencias Médicas y Nutrición; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; P.R. Fortin, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, CHU de Québec - Université Laval; J. Sanchez-Guerrero, MD, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine-University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University Health Centre; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; D. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine, University of California Los Angeles; D.A. Isenberg, MD, Centre for Rheumatology Research, University College London; A. Rahman, MD, PhD, Centre for Rheumatology Research, University College London; J. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E. Ginzler, MD, PhD, Department of Medicine, SUNY Downstate Medical Center; G.S. Alarcón, MD, MPH, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; W.W. Chatham, MD, Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; M. Petri, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; M. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; M.A. Dooley, MD, MPH, Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina; S. Manzi, MD, MPH, Autoimmunity Institute, Allegheny Health Network; R. Ramsey-Goldman, MD, DrPH, Northwestern University and Feinberg School of Medicine; O. Nived, MD, PhD, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University; K. Steinsson, MD, Department of Rheumatology, Center for Rheumatology Research Fossvogur Landspitali University Hospital; A. Zoma, MD, Lanarkshire Centre for Rheumatology, Hairmyres Hospital; G. Ruiz-Irastorza, MD, Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, BioCruces Health Research Institute, University of the Basque Country; S. Lim, MD, MPH, Division of Rheumatology, Emory University School of Medicine; K. Kalunian, MD, University of California San Diego School of Medicine; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R. van Vollenhoven, MD, ClinTRID, Karolinska University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Division of Rheumatology, Medical University of South Carolina; S. Jacobsen, MD, DMSc, Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital; C. Peschken, MD, FRCPC, Associate Professor of Medicine, Department of Medicine and Community Health Sciences, University of Manitoba; A. Askanase, MD, MPH, Division of Rheumatology, Columbia University Medical Center; T. Stoll, MD, Department of Rheumatology, Kantousspital; I.N. Bruce, MD, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust; J. Wetterö, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University; C. Sjöwall, MD, PhD, Rheumatology/Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University
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Urowitz MB, Ohsfeldt RL, Wielage RC, Kelton KA, Asukai Y, Ramachandran S. Organ damage in patients treated with belimumab versus standard of care: a propensity score-matched comparative analysis. Ann Rheum Dis 2019; 78:372-379. [PMID: 30610066 PMCID: PMC6390027 DOI: 10.1136/annrheumdis-2018-214043] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/01/2018] [Accepted: 11/12/2018] [Indexed: 11/04/2022]
Abstract
Objectives The study (206347) compared organ damage progression in patients with systemic lupus erythematosus (SLE) who received belimumab in the BLISS long-term extension (LTE) study with propensity score (PS)-matched patients treated with standard of care (SoC) from the Toronto Lupus Cohort (TLC). Methods A systematic literature review identified 17 known predictors of organ damage to calculate a PS for each patient. Patients from the BLISS LTE and the TLC were PS matched posthoc 1:1 based on their PS (±calliper). The primary endpoint was difference in change in Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) score from baseline to 5 years. Results For the 5- year analysis, of 567 (BLISS LTE n=195; TLC n=372) patients, 99 from each cohort were 1:1 PS matched. Change in SDI score at Year 5 was significantly lower for patients treated with belimumab compared with SoC (−0.434; 95% CI –0.667 to –0.201; p<0.001). For the time to organ damage progression analysis (≥1 year follow-up), the sample included 965 (BLISS LTE n=259; TLC n=706) patients, of whom 179 from each cohort were PS-matched. Patients receiving belimumab were 61% less likely to progress to a higher SDI score over any given year compared with patients treated with SoC (HR 0.391; 95% CI 0.253 to 0.605; p<0.001). Among the SDI score increases, the proportion of increases ≥2 was greater in the SoC group compared with the belimumab group. Conclusions PS-matched patients receiving belimumab had significantly less organ damage progression compared with patients receiving SoC.
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Affiliation(s)
- Murray B Urowitz
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Robert L Ohsfeldt
- School of Public Health, Texas A&M University, College Station, Texas, USA.,Medical Decision Modeling Inc, Indianapolis, Indiana, USA
| | | | - Kari A Kelton
- Medical Decision Modeling Inc, Indianapolis, Indiana, USA
| | - Yumi Asukai
- Value Evidence & Outcomes, GSK, Brentford, UK
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Mendel A, Bernatsky SB, Hanly JG, Urowitz MB, Clarke AE, Romero-Diaz J, Gordon C, Bae SC, Wallace DJ, Merrill JT, Buyon JP, Isenberg DA, Rahman A, Ginzler EM, Petri M, Dooley MA, Fortin PR, Gladman DD, Steinsson K, Ramsey-Goldman R, Khamashta MA, Aranow C, Mackay M, Alarcón GS, Manzi S, Nived O, Jönsen A, Zoma AA, van Vollenhoven RF, Ramos-Casals M, Ruiz-Irastorza G, Lim S, Kalunian KC, Inanc M, Kamen DL, Peschken CA, Jacobsen S, Askanase A, Sanchez-Guerrero J, Bruce IN, Costedoat-Chalumeau N, Vinet É. Low aspirin use and high prevalence of pre-eclampsia risk factors among pregnant women in a multinational SLE inception cohort. Ann Rheum Dis 2018; 78:1010-1012. [PMID: 30573656 PMCID: PMC6585274 DOI: 10.1136/annrheumdis-2018-214434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/21/2018] [Accepted: 12/03/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Arielle Mendel
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sasha B Bernatsky
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada.,Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - John G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Murray B Urowitz
- Lupus Program, Centre for Prognosis Studies in the Rheumatic Disease and Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ann Elaine Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Juanita Romero-Diaz
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición, Tlalpan, Mexico
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Rheumatology Department, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Daniel J Wallace
- Cedars-Sinai Medical Centre, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Joan T Merrill
- Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York School of Medicine, New York City, New York, USA
| | - David A Isenberg
- Department of Medicine, Centre for Rheumatology, University College London, London, UK
| | - Anisur Rahman
- Department of Medicine, Centre for Rheumatology, University College London, London, UK
| | - Ellen M Ginzler
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary Anne Dooley
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Paul R Fortin
- Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Québec City, Quebec, Canada
| | - Dafna D Gladman
- Lupus Program, Centre for Prognosis Studies in the Rheumatic Disease and Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kristján Steinsson
- Center for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland
| | - Rosalind Ramsey-Goldman
- Division of Rheumatology, Feinberg School of Medicine, Northwestern University Chicago, Chicago, Illinois, USA
| | - Munther A Khamashta
- Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK
| | - Cynthia Aranow
- Lupus Center of Excellence, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Meggan Mackay
- Lupus Center of Excellence, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Graciela S Alarcón
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Susan Manzi
- Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Ola Nived
- Department of Clinical Sciences and Rheumatology, Lund University, Lund, Sweden
| | - Andreas Jönsen
- Department of Clinical Sciences and Rheumatology, Lund University, Lund, Sweden
| | - Asad A Zoma
- Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK
| | | | - Manuel Ramos-Casals
- Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Sam Lim
- Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ken C Kalunian
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Diane L Kamen
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Section 4242, Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anca Askanase
- Hospital for Joint Diseases, Seligman Centre for Advanced Therapeutics, New York University, New York City, New York, USA
| | - Jorge Sanchez-Guerrero
- Department of Rheumatology, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ian N Bruce
- NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Nathalie Costedoat-Chalumeau
- Centre de Reference Maladies Auto-immunes et Systemiques Rares, Service de Medecine Interne, Hospital Cochin, Paris, France
| | - Évelyne Vinet
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada .,Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
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Abstract
BACKGROUND Disease activity in systemic lupus erythematosus follows three different courses: long quiescent, relapsing remitting and persistently active. However, the patterns of disease course since diagnosis are not known. This study aimed to assess the prevalence and characteristics of such patterns over 10 years. PATIENTS AND METHODS The inception cohort of the Toronto Lupus Clinic (≥10 year follow up, between visit interval ≤18 months) was investigated. Prolonged remission was defined as a clinical Systemic Lupus Erythematosus Disease Activity Index 2000 = 0 achieved within 5 years of enrolment and maintained for ≥10 years. The relapsing-remitting pattern was defined based on ≥2 remission periods (clinical Systemic Lupus Erythematosus Disease Activity Index 2000 = 0 for two consecutive visits). Patients with no remission were categorized as persistently active. Groups were compared for baseline characteristics, cumulative damage, flare rate, mortality and certain co-morbidities. RESULTS Of 267 patients, 27 (10.1%) achieved prolonged remission, 180 (67.4%) relapsing-remitting and 25 (9.4%) persistently active. In total, 35 (13.1%) had only one remission period (hybrid). At enrollment, there were no differences regarding clinical and immunological variables. At 10 years, persistently active patients had accumulated significantly more damage than the prolonged remission and relapsing-remitting patients. Being of Black race and higher adjusted mean Systemic Lupus Erythematosus Disease Activity Index 2000 over the first 2 years were associated with a more severe disease course. Relapsing-remitting and persistently active patients had an increased flare rate and accrued more osteoporosis, osteonecrosis and cardiovascular events. CONCLUSIONS Approximately 70% of systemic lupus erythematosus patients followed a relapsing-remitting course, whereas 10% displayed prolonged remission and another 10% a persistently active course. Early response to treatment was associated with a less severe course and better prognosis.
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Affiliation(s)
- K Tselios
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, Toronto, Canada
| | - D D Gladman
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, Toronto, Canada
| | - Z Touma
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, Toronto, Canada
| | - J Su
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, Toronto, Canada
| | - N Anderson
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, Toronto, Canada
| | - M B Urowitz
- Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, Toronto, Canada
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Tselios K, Yap KSY, Pakchotanon R, Polachek A, Su J, Urowitz MB, Gladman DD. Correction to: Psoriasis in systemic lupus erythematosus: a single-center experience. Clin Rheumatol 2018; 38:269. [PMID: 30430267 DOI: 10.1007/s10067-018-4363-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Prof. Ari Polachek on of the author of the published version of this article missed to add his second affiliation which is the Department of Rheumatology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. The new affiliation is now added and presented correctly in this article.
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Affiliation(s)
- Konstantinos Tselios
- Centre for Prognosis Studies in the Rheumatic Diseases Toronto Western Hospital, University of Toronto Lupus Clinic, University Health Network, 399 Bathurst St. 1E-410B, Toronto, ON, M5T 2S8, Canada
| | - Kristy Su-Ying Yap
- Centre for Prognosis Studies in the Rheumatic Diseases Toronto Western Hospital, University of Toronto Lupus Clinic, University Health Network, 399 Bathurst St. 1E-410B, Toronto, ON, M5T 2S8, Canada
| | - Rattapol Pakchotanon
- Centre for Prognosis Studies in the Rheumatic Diseases Toronto Western Hospital, University of Toronto Lupus Clinic, University Health Network, 399 Bathurst St. 1E-410B, Toronto, ON, M5T 2S8, Canada
| | - Ari Polachek
- Centre for Prognosis Studies in the Rheumatic Diseases Toronto Western Hospital, University of Toronto Lupus Clinic, University Health Network, 399 Bathurst St. 1E-410B, Toronto, ON, M5T 2S8, Canada
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jiandong Su
- Centre for Prognosis Studies in the Rheumatic Diseases Toronto Western Hospital, University of Toronto Lupus Clinic, University Health Network, 399 Bathurst St. 1E-410B, Toronto, ON, M5T 2S8, Canada
| | - Murray B Urowitz
- Centre for Prognosis Studies in the Rheumatic Diseases Toronto Western Hospital, University of Toronto Lupus Clinic, University Health Network, 399 Bathurst St. 1E-410B, Toronto, ON, M5T 2S8, Canada
| | - Dafna D Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases Toronto Western Hospital, University of Toronto Lupus Clinic, University Health Network, 399 Bathurst St. 1E-410B, Toronto, ON, M5T 2S8, Canada.
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Tselios K, Deeb M, Gladman DD, Harvey P, Akhtari S, Mak S, Butany J, Urowitz MB. Antimalarial-induced Cardiomyopathy in Systemic Lupus Erythematosus: As Rare as Considered? J Rheumatol 2018; 46:391-396. [PMID: 30323009 DOI: 10.3899/jrheum.180124] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Antimalarials (AM) are recommended for all systemic lupus erythematosus (SLE) patients without specific contraindications. Their main adverse effect is retinal damage; however, heart disease has been described in isolated cases. The aim of our study is to describe 8 patients with AM-induced cardiomyopathy (AMIC) in a defined SLE cohort. METHODS Patients attending the Toronto Lupus Clinic and diagnosed with definite (based on endomyocardial biopsy; EMB) and possible AMIC were included [based on cardiac magnetic resonance imaging (cMRI) and other investigations]. RESULTS Eight female patients (median age 62.5 yrs, disease duration 35 yrs, AM use duration 22 yrs) were diagnosed with AMIC in the past 2 years. Diagnosis was based on EMB in 3 (extensive cardiomyocyte vacuolation, intracytoplasmic myelinoid, and curvilinear bodies). In 4 patients, cMRI was highly suggestive of AMIC (ventricular hypertrophy and/or atrial enlargement and late gadolinium enhancement in a nonvascular pattern). Another patient was diagnosed with complete atrioventricular block, left ventricular and septal hypertrophy, along with concomitant ocular toxicity. All patients had abnormal cardiac troponin I (cTnI) and brain natriuretic peptide (BNP), whereas 7/8 also had chronically elevated creatine phosphokinase. During followup, 1 patient died from refractory heart failure. In the remaining patients, hypertrophy regression and a steady decrease of heart biomarkers were observed after AM cessation. CONCLUSION Once considered extremely rare, AMIC seems to be underrecognized, probably because of the false attribution of heart failure or hypertrophy to other causes. Certain biomarkers (cTnI, BNP) and imaging findings may lead to early diagnosis and enhance survival.
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Affiliation(s)
- Konstantinos Tselios
- From the University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network; University of Toronto, Krembil Research Institute; Department of Cardiology, University of Toronto, Women's College Hospital; Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.,K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; M. Deeb, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Co-Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; P. Harvey, BMBS, PhD, FRACP, Department of Cardiology, University of Toronto, Women's College Hospital; S. Akhtari, MD, FRCPC, Department of Cardiology, University of Toronto, Women's College Hospital; S. Mak, MD, PhD, Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; J. Butany, MBBS, MS, FRCPC, Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases
| | - Mery Deeb
- From the University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network; University of Toronto, Krembil Research Institute; Department of Cardiology, University of Toronto, Women's College Hospital; Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.,K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; M. Deeb, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Co-Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; P. Harvey, BMBS, PhD, FRACP, Department of Cardiology, University of Toronto, Women's College Hospital; S. Akhtari, MD, FRCPC, Department of Cardiology, University of Toronto, Women's College Hospital; S. Mak, MD, PhD, Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; J. Butany, MBBS, MS, FRCPC, Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases
| | - Dafna D Gladman
- From the University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network; University of Toronto, Krembil Research Institute; Department of Cardiology, University of Toronto, Women's College Hospital; Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.,K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; M. Deeb, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Co-Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; P. Harvey, BMBS, PhD, FRACP, Department of Cardiology, University of Toronto, Women's College Hospital; S. Akhtari, MD, FRCPC, Department of Cardiology, University of Toronto, Women's College Hospital; S. Mak, MD, PhD, Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; J. Butany, MBBS, MS, FRCPC, Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases
| | - Paula Harvey
- From the University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network; University of Toronto, Krembil Research Institute; Department of Cardiology, University of Toronto, Women's College Hospital; Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.,K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; M. Deeb, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Co-Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; P. Harvey, BMBS, PhD, FRACP, Department of Cardiology, University of Toronto, Women's College Hospital; S. Akhtari, MD, FRCPC, Department of Cardiology, University of Toronto, Women's College Hospital; S. Mak, MD, PhD, Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; J. Butany, MBBS, MS, FRCPC, Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases
| | - Shadi Akhtari
- From the University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network; University of Toronto, Krembil Research Institute; Department of Cardiology, University of Toronto, Women's College Hospital; Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.,K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; M. Deeb, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Co-Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; P. Harvey, BMBS, PhD, FRACP, Department of Cardiology, University of Toronto, Women's College Hospital; S. Akhtari, MD, FRCPC, Department of Cardiology, University of Toronto, Women's College Hospital; S. Mak, MD, PhD, Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; J. Butany, MBBS, MS, FRCPC, Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases
| | - Susanna Mak
- From the University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network; University of Toronto, Krembil Research Institute; Department of Cardiology, University of Toronto, Women's College Hospital; Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.,K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; M. Deeb, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Co-Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; P. Harvey, BMBS, PhD, FRACP, Department of Cardiology, University of Toronto, Women's College Hospital; S. Akhtari, MD, FRCPC, Department of Cardiology, University of Toronto, Women's College Hospital; S. Mak, MD, PhD, Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; J. Butany, MBBS, MS, FRCPC, Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases
| | - Jagdish Butany
- From the University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network; University of Toronto, Krembil Research Institute; Department of Cardiology, University of Toronto, Women's College Hospital; Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.,K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; M. Deeb, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Co-Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; P. Harvey, BMBS, PhD, FRACP, Department of Cardiology, University of Toronto, Women's College Hospital; S. Akhtari, MD, FRCPC, Department of Cardiology, University of Toronto, Women's College Hospital; S. Mak, MD, PhD, Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; J. Butany, MBBS, MS, FRCPC, Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases
| | - Murray B Urowitz
- From the University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network; University of Toronto, Krembil Research Institute; Department of Cardiology, University of Toronto, Women's College Hospital; Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada. .,K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; M. Deeb, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Co-Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; P. Harvey, BMBS, PhD, FRACP, Department of Cardiology, University of Toronto, Women's College Hospital; S. Akhtari, MD, FRCPC, Department of Cardiology, University of Toronto, Women's College Hospital; S. Mak, MD, PhD, Mecklinger Family and Posluns Family Cardiac Catheterization Research Laboratory, Department of Medicine, Division of Cardiology, Mount Sinai Hospital, University of Toronto; J. Butany, MBBS, MS, FRCPC, Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto General Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases.
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Hanly JG, Li Q, Su L, Urowitz MB, Gordon C, Bae SC, Romero-Diaz J, Sanchez-Guerrero J, Bernatsky S, Clarke AE, Wallace DJ, Isenberg DA, Rahman A, Merrill JT, Fortin P, Gladman DD, Bruce IN, Petri M, Ginzler EM, Dooley MA, Steinsson K, Ramsey-Goldman R, Zoma AA, Manzi S, Nived O, Jonsen A, Khamashta MA, Alarcón GS, Chatham W, van Vollenhoven RF, Aranow C, Mackay M, Ruiz-Irastorza G, Ramos-Casals M, Lim SS, Inanc M, Kalunian KC, Jacobsen S, Peschken CA, Kamen DL, Askanase A, Theriault C, Farewell V. Cerebrovascular Events in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. Arthritis Care Res (Hoboken) 2018; 70:1478-1487. [PMID: 29316357 DOI: 10.1002/acr.23509] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 01/02/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine the frequency, characteristics, and outcomes of cerebrovascular events (CerVEs), as well as clinical and autoantibody associations in a multiethnic/racial inception cohort of patients with systemic lupus erythematosus (SLE). METHODS A total of 1,826 patients were assessed annually for 19 neuropsychiatric (NP) events, including 5 types of CerVEs: 1) stroke, 2) transient ischemia, 3) chronic multifocal ischemia, 4) subarachnoid/intracranial hemorrhage, and 5) sinus thrombosis. Global disease activity (Systemic Lupus Erythematosus Disease [SLE] Activity Index 2000), damage scores (SLE International Collaborating Clinics/American College of Rheumatology Damage Index), and Short Form 36 (SF-36) scores were collected. Time to event, linear and logistic regressions, and multistate models were used as appropriate. RESULTS CerVEs were the fourth most frequent NP event: 82 of 1,826 patients had 109 events; of these events, 103 were attributed to SLE, and 44 were identified at the time of enrollment. The predominant events were stroke (60 of 109 patients) and transient ischemia (28 of 109 patients). CerVEs were associated with other NP events attributed to SLE, non-SLE-attributed NP events, African ancestry (at US SLICC sites), and increased organ damage scores. Lupus anticoagulant increased the risk of first stroke and sinus thrombosis and transient ischemic attack. Physician assessment indicated resolution or improvement in the majority of patients, but patients reported sustained reduction in SF-36 summary and subscale scores following a CerVE. CONCLUSION CerVEs, the fourth most frequent NP event in SLE, are usually attributable to lupus. In contrast to good physician-reported outcomes, patients reported a sustained reduction in health-related quality of life following a CerVE.
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Affiliation(s)
- John G Hanly
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Qiuju Li
- MRC Biostatistics Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Li Su
- MRC Biostatistics Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Murray B Urowitz
- Toronto Western Hospital and University of Toronto, Ontario, Canada
| | - Caroline Gordon
- University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK
| | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | | | | | | | | | - Daniel J Wallace
- Cedars-Sinai Medical Center and University of California at Los Angeles, David Geffen School of Medicine, Los Angeles
| | | | | | | | - Paul Fortin
- Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Canada
| | - Dafna D Gladman
- Toronto Western Hospital and University of Toronto, Ontario, Canada
| | - Ian N Bruce
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK, and Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ellen M Ginzler
- State University of New York Downstate Medical Center, Brooklyn
| | - M A Dooley
- University of North Carolina, Chapel Hill
| | | | | | - Asad A Zoma
- Lanarkshire Centre for Rheumatology and Hairmyres Hospital, East Kilbride, Scotland UK
| | - Susan Manzi
- Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania
| | | | | | - Munther A Khamashta
- Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London, UK
| | | | | | | | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | - Meggan Mackay
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | - Manuel Ramos-Casals
- Institut d'Investigacions Biomèdiques August Pi I Sunyer, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | | | | | | | - Soren Jacobsen
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | - Chris Theriault
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vernon Farewell
- MRC Biostatistics Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
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Barber MRW, Hanly JG, Su L, Urowitz MB, St Pierre Y, Romero-Diaz J, Gordon C, Bae SC, Bernatsky S, Wallace DJ, Isenberg DA, Rahman A, Ginzler EM, Petri M, Bruce IN, Fortin PR, Gladman DD, Sanchez-Guerrero J, Ramsey-Goldman R, Khamashta MA, Aranow C, Mackay M, Alarcón GS, Manzi S, Nived O, Jönsen A, Zoma AA, van Vollenhoven RF, Ramos-Casals M, Ruiz-Irastorza G, Lim SS, Kalunian KC, Inanc M, Kamen DL, Peschken CA, Jacobsen S, Askanase A, Theriault C, Farewell V, Clarke AE. Economic Evaluation of Lupus Nephritis in the Systemic Lupus International Collaborating Clinics Inception Cohort Using a Multistate Model Approach. Arthritis Care Res (Hoboken) 2018; 70:1294-1302. [PMID: 29193883 DOI: 10.1002/acr.23480] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 11/21/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Little is known about the long-term costs of lupus nephritis (LN). The costs were compared between patients with and without LN using multistate modeling. METHODS Patients from 32 centers in 11 countries were enrolled in the Systemic Lupus International Collaborating Clinics inception cohort within 15 months of diagnosis and provided annual data on renal function, hospitalizations, medications, dialysis, and selected procedures. LN was diagnosed by renal biopsy or the American College of Rheumatology classification criteria. Renal function was assessed annually using the estimated glomerular filtration rate (GFR) or estimated proteinuria. A multistate model was used to predict 10-year cumulative costs by multiplying annual costs associated with each renal state by the expected state duration. RESULTS A total of 1,545 patients participated; 89.3% were women, the mean ± age at diagnosis was 35.2 ± 13.4 years, 49% were white, and the mean followup duration was 6.3 ± 3.3 years. LN developed in 39.4% of these patients by the end of followup. Ten-year cumulative costs were greater in those with LN and an estimated glomerular filtration rate (GFR) <30 ml/minute ($310,579 2015 Canadian dollars versus $19,987 if no LN and estimated GFR >60 ml/minute) or with LN and estimated proteinuria >3 gm/day ($84,040 versus $20,499 if no LN and estimated proteinuria <0.25 gm/day). CONCLUSION Patients with estimated GFR <30 ml/minute incurred 10-year costs 15-fold higher than those with normal estimated GFR. By estimating the expected duration in each renal state and incorporating associated annual costs, disease severity at presentation can be used to anticipate future health care costs. This is critical knowledge for cost-effectiveness evaluations of novel therapies.
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Affiliation(s)
| | - John G Hanly
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Li Su
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Murray B Urowitz
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Yvan St Pierre
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | | | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | | | - Daniel J Wallace
- Cedars-Sinai/David Geffen School of Medicine at the University of California, Los Angeles
| | | | | | - Ellen M Ginzler
- State University of New York Downstate Medical Center, Brooklyn, New York
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ian N Bruce
- Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, the University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Dafna D Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Jorge Sanchez-Guerrero
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Munther A Khamashta
- Lupus Research Unit, The Rayne Institute, St Thomas's Hospital, King's College London School of Medicine, London, UK
| | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | - Meggan Mackay
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | - Susan Manzi
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | - Asad A Zoma
- Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK
| | | | - Manuel Ramos-Casals
- Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
| | - Guillermo Ruiz-Irastorza
- BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - S Sam Lim
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | - Soren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anca Askanase
- Hospital for Joint Diseases, New York University Seligman Center for Advanced Therapeutics, New York, New York
| | - Chris Theriault
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vernon Farewell
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
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Tselios K, Urowitz MB. Cardiovascular and Pulmonary Manifestations of Systemic Lupus Erythematosus. Curr Rheumatol Rev 2018; 13:206-218. [PMID: 28675998 DOI: 10.2174/1573397113666170704102444] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/02/2017] [Accepted: 06/18/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is characterized by various clinical manifestations and immunologic abnormalities. Cardiovascular and respiratory system involvement are increasingly recognized as critical for patients' prognosis. In this review, current knowledge concerning diagnosis, pathogenesis and treatment of the cardiac and pulmonary lupus manifestations are discussed. METHOD Review of the literature. RESULTS Although pericarditis is the most frequent heart manifestation in the context of lupus, valvular disease and less often myocarditis may be detected. In the latter, treatment should be prompt and aggressive to prevent chronic sequelae like congestive heart failure. Later on disease course, accelerated atherosclerosis is considered as one of the most important co-morbidities of SLE with cardiovascular events being one of the leading causes of death at relatively young ages. Stratification of the patients at risk and stringent management of the traditional risk factors are warranted. Respiratory system involvement affects all anatomic structures of the lungs, pleura and pulmonary vasculature while its severity ranges from asymptomatic pleural disease to acute respiratory failure. The most common features include pleuritis, interstitial lung disease and pulmonary embolism on the background of antiphospholipid syndrome. Less usual complications include lupus pneumonitis, diffuse alveolar hemorrhage, shrinking lung syndrome and pulmonary arterial hypertension. CONCLUSION There are no specific guidelines for the management of these manifestations and therapeutic approach remains empiric.
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Affiliation(s)
- Konstantinos Tselios
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Ontario. Canada
| | - Murray B Urowitz
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Ontario. Canada
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