BackgroundAccurate measurement of disease activity is a cornerstone in the management of patients with Systemic Lupus Erythematosus (SLE), to assist in guiding therapeutic decisions. SLE-DAS (SLE Disease Activity Score) is designed to improve accuracy and sensitivity to change compared with the standard SLE Disease Activity Index (SLEDAI) score.ObjectivesWe aimed to assess the performance of SLE-DAS to identify flare and clinically meaningful improvement (CMI) in real-life SLE patients in India.MethodsProspective observational study at an Indian Rheumatology Clinic included SLE patients meeting 2012 SLICC and/or 2019 ACR/EULAR criteria, followed for 9 months. At baseline and subsequent follow-up, we recorded SLEDAI-2K, SLE-DAS, PGA, LLDAS, DORIS remission, prednisolone dose, and immunosuppressives; SELENA-SLEDAI flare index (SFI) was evaluated at follow-up. We assessed Spearman correlation, agreement, and discrepancies between SLEDAI and SLE-DAS for flare and improvement detection using an agreement matrix.ResultsA strong correlation was observed between SLEDAI-2K and SLE-DAS (rho = 0.954, 95% CI 0.934-0.968, p < 0.001). SLE-DAS identified CMI in 42.0% of visits compared to 34.8% by SLEDAI-2K. Flare detection sensitivity was higher for SLE-DAS (96%) than SLEDAI-2K (84%), with similar specificity (98.9%). The agreement of SLEDAS remission and low disease activity (LDA) with DORIS remission and LLDAS, respectively, was perfect (κ = 1, p < 0.001). Discordant analysis revealed that SLEDAI-2K underestimated severe flares and missed manifestations such as pneumonitis, AIHA, and serositis.ConclusionSLE-DAS demonstrated superior sensitivity, granularity, and remission alignment compared to SLEDAI-2K, supporting its adoption as a primary clinical index in diverse real-world lupus practices.

ObjectivePericarditis is a common and recurring manifestation of systemic lupus erythematosus (SLE). While guidelines for the management of SLE include the use of non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, and glucocorticoids, the evidence for various treatments in SLE is limited. Evidence for the usage of colchicine for pericarditis in patients with SLE exists primarily in case reports and case series. The purpose of this study was to investigate colchicine usage and rates of recurrent pericarditis among patients with SLE.MethodsThis retrospective cohort study included patients with SLE treated at a tertiary care center between 2015 and 2025. Patients were included if they presented to the hospital with pericarditis based on the 2025 European Society of Cardiology (ESC) Guidelines and had follow-up for at least 1 year. Based on the ESC guidelines, recurrent pericarditis was defined as new symptoms or disease activity after clinical remission and was captured within 1 year of the initial presentation.ResultsOf the 55 patients included in the study, 47.3% received colchicine, 52.7% received NSAIDs and 56.4% received glucocorticoids. Recurrent pericarditis occurred in 45.5% of patients. In univariate analyses, age less than 40 years at first presentation of pericarditis was significantly associated with recurrent pericarditis as was treatment with an initiation or increase of glucocorticoids. Treatment with colchicine trended toward reduced recurrence, but the result was not statistically significant. In multivariate logistic regression including age, treatment with colchicine, and treatment with glucocorticoids, only treatment with glucocorticoids was significantly associated with recurrent pericarditis (odds ratio 4.31; 95% confidence interval 1.12-16.55).ConclusionsIn this study, recurrent pericarditis was common among patients with SLE and was associated with treatment with glucocorticoids. Colchicine was associated with a trend toward decreased recurrence rates, but this was not statistically significant. Given high recurrence rates among patients treated with steroids, additional studies are needed on non-steroidal therapies for pericarditis in SLE, including further research on colchicine.

ObjectiveTo study the clinical features and outcomes of macrophage activation syndrome in lupus.MethodsThis was a retrospective study conducted in a tertiary care referral centre from 2017 to 2022. Consecutive hospitalised adult-onset SLE patients diagnosed with MAS, fulfilling the Parodi criteria with ferritin >500 ng/ml were included. All the other hospitalised SLE patients without MAS served as controls. Clinical and immunological features and in-hospital mortality was compared between the 2 groups. Risk factors for mortality in MAS patients were determined performing univariate and multivariate analyses with a stepwise logistic regression.ResultsOf 623 hospitalisations in 451 SLE patients, 86 met the case definition for MAS and 526 served as controls. MAS occurred at the time of SLE diagnosis in 54 (62.9%). MAS was associated with fever, hepatosplenomegaly, lymphadenopathy, cytopenia, and elevated transaminases. Disease activity (clinical SLEDAI 2K) was significantly higher in MAS (mean 13.7 ± 6.5 vs. 8 ± 5.9 (p < 0.001). In-hospital mortality was higher in the MAS compared to the control group [13 (15%) vs 6 (1%), p < 0.001]. Mortality in MAS was associated with higher ferritin (12092.9 ± 2826.5 vs 3993.6 ± 735, <0.001) and aspartate aminotransferase (544 ± 239 vs 167.66 ± 27.28U/L, p < 0.001), seizures (p = 0.035), altered mental status (p = 0.004), shock (p < 0.001), intensive care unit admission (p < 0.001), and mechanical ventilation (p < 0.001). On multivariate regression analysis -ferritin >2400{OR-8.1 95% CI: (1.46-44.85) p - 0.017} and seizures {OR-7.3 95% CI: (1.2-44.29) p - 0.030} were associated with mortality in MAS.ConclusionsMAS is a rare complication of active lupus identified by fever, elevated ferritin, liver transaminases and cytopenia and is associated with high in hospital mortality.

BackgroundSystemic lupus erythematosus (SLE) is a complex autoimmune condition with a high level of morbidity, mortality and healthcare costs. In New Zealand prevalence of the condition has been increasing over time, although studies to date are based on national administrative datasets or hospital records.ObjectiveWe aimed to estimate the prevalence of SLE based on primary care medical records in New Zealand and to evaluate the differences in age, gender and ethnicity.MethodsPotential SLE cases were identified through electronic primary care records from 1 January 2000 to 20 March 2024. All records were manually reviewed to identify the diagnosis based on 2019 European League Against Rheumatism/American College of Rheumatology classification criteria. Prevalence was based on definite and probable cases.ResultsSixty-eight SLE cases were identified (55 definite, 6 probable, 7 possible) from a total practice population of 96,348. The crude prevalence of SLE estimated using primary care records was 63.3 per 100,000 people in 2024. The World Health Organization age-standardised prevalence was 52.9 per 100,000 people in 2024. SLE prevalence generally increased with advancing age. Women were five times more likely than men to have SLE (RR 5.36, 95% CI 2.63 - 10.93. Pacific people had the highest age-standardised prevalence of SLE (94.1), followed by Asian (58.7), European/Others (48.3) and Māori (42.9 per 100,000).ConclusionThe use of primary care medical records builds on national studies based primarily on administrative databases. Prevalence of SLE is highest in the elderly (>85 years), females and Pacific people based on primary care data in New Zealand.

BackgroundLupus nephritis (LN) affects over 60% of patients with systemic lupus erythematosus and is a risk factor for progression to end stage kidney disease. Guidelines recommend high dose parenteral methylprednisolone "pulses" for induction, although intravenous pulse therapy has not been rigorously compared to oral therapy. In this observational study, we report the outcomes of 17 patients who initiated therapy for LN with high dose oral dexamethasone.MethodsLN patients treated with oral dexamethasone between December 2021, and January 2025, were identified and baseline characteristics were recorded. Patients were assessed for a complete renal response (CRR, uPCR < 500, eGFR > 80%), satisfactory renal response (SRR, uPCR < 700, eGFR > 80%), or partial renal response (PRR, uPCR ≤ half of baseline uPCR, eGFR > 80%) at 1 year after receipt of dexamethasone. Responses were compared to outcomes in the BLISS-LN, AURORA and REGENCY trials.ResultsSeventeen patients with LN treated with induction dexamethasone were identified. The average age was 40 years old, and 15 patients were female. Six patients were of African ancestry, four Hispanic ethnicity, and three were White. Fourteen patients had proliferative LN. 47% of patients achieved a CRR, 59% obtained a SRR, and 53% obtained a PRR. Renal outcomes compared favorably to outcomes in the active arms of the BLISS-LN, AURORA 1, and REGENCY studies. Biomarkers including C3, C4, and dsDNA antibodies improved throughout the period. Proteinuria declined in 14 of 17 patients.ConclusionPatients with LN initially treated with oral dexamethasone in place of intravenous pulse methylprednisolone achieved responses similar to outcomes in recent LN trials. Dexamethasone is a promising potential oral option to initiate treatment for LN obviating need for parenteral therapy.

IntroductionSystemic Lupus Erythematosus (SLE) and lupus nephritis (LN) carry substantial cardiorenal risks. Conventional immunosuppressive therapies primarily target inflammation but leave a burden of residual renal and metabolic damage. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) provide clear cardiorenal protection in general populations, but data specific to SLE remains limited. This systematic review and meta-analysis evaluated the efficacy and safety of SGLT2i in patients with SLE and LN.MethodsComprehensive searches across five electronic databases (PubMed, Cochrane CENTRAL, Web of Science, Embase, and Scopus) were conducted up to April 2026 to identify randomized controlled trials (RCTs) and observational studies assessing SGLT2i in adult SLE/LN patients. Random-effects meta-analyses were performed to synthesize cardiorenal and safety outcomes using R Software.ResultsSix studies published between 2024 and 2025 were included. Pooled data demonstrated that SGLT2i use was associated with a significant improvement in estimated glomerular filtration rate (eGFR) compared to controls (MD: 4.02; 95% CI: 1.39-6.65; I[2] = 60.1%). SGLT2i significantly reduced the risks of progression to end-stage kidney disease (RR: 0.37; 95% CI: 0.25-0.56; I[2] = 11.0%), heart failure development (RR: 0.65; 95% CI: 0.56-0.75; I[2] = 0.0%), incident lupus nephritis (RR: 0.58; 95% CI: 0.44-0.76; I[2] = 0.0%), and re-hospitalizations (RR: 0.67; 95% CI: 0.57-0.79; I[2] = 0.0%). Furthermore, a significant reduction in all-cause mortality was observed (RR: 0.55; 95% CI: 0.36-0.86; I[2] = 76.2%). SGLT2i treatment demonstrated an acceptable safety profile across the included cohorts. The certainty of evidence for these findings was rated as low to very low, and results remain vulnerable to residual confounding from variables such as disease activity, corticosteroid burden, and immunosuppressive regimen.ConclusionPreliminary exploratory evidence suggests potential associations between SGLT2 inhibitors and cardiorenal outcomes in lupus nephritis. Given the low certainty of evidence and vulnerability to residual confounding from disease-specific variables, these hypothesis-generating findings require confirmation in well-designed randomized controlled trials.

Background: Greater than 50% of individuals with systemic lupus erythematosus (SLE) will develop cardiovascular disease (CVD). Moderate-intensity aerobic exercise significantly reduces CVD risk, morbidity, and mortality, yet most persons with SLE do not meet the minimum recommendations for physical activity.Purpose: To explore specific barriers to exercise that afflict those with both SLE and CVD, as well as how these factors may change over time.Research Design: Qualitative.Study Sample: Individuals with self-reported SLE and CVD.Data Collection: Researchers conducted 1:1 semi-structured interviews and administered a battery of surveys. Analysis. Researchers used an inductive, interpretive phenomenological analysis qualitative approach to understand patients' perspectives on what influences perception and decision-making of exercise.Results: Five participants completed the study. Four overarching themes were identified. The first, "Short-term Risks versus Long-term Benefits of Exercise," exemplifies the temporal nature of the perception of exercise risk throughout the diagnostic timeline and explains how this relationship changes over time. The second, "Pacing," defines the struggle that these participants face when allocating energy to everyday tasks. The third, "Foundational and Nurturing Supports for Exercise," describes the impact that medical and family/friends have on exercise adherence as primary methods of support. The fourth highlights a "Need for Tailored Intervention" for each patient with SLE and CVD, as general recommendations from health professionals are often described as difficult to adhere to.Conclusion: Understanding exercise adherence in this population represents a dynamic and individualized process. The success of long-term decisions to engage in exercise may result from targeting natural intervention areas across the diagnostic timeline, encouraging support from healthcare providers, friends, and family members, and implementing personalized exercise programs for this population.

BackgroundSystemic lupus erythematosus (SLE) is an autoimmune disease associated with increased cardiovascular risk and gut microbiota dysbiosis. Although lifestyle can modulate the microbiome, the impact of multidisciplinary interventions in SLE remains unclear. Thus, the aim of the present study was to investigate the effects of a multidisciplinary lifestyle intervention on gut microbiota diversity and composition in women with SLE and high cardiovascular risk.Materials and methodsThis study analyzed a subsample (n = 31) from the "Living Well with Lupus" (LWWL) study, a 6-month randomized controlled trial. Patients were assigned to a lifestyle intervention + standard care (LWWL) or a standard care control group (CG). Gut microbiota (16S rRNA sequencing), fecal short-chainfatty acids (SCFAs), selected cardiovascular risk factors, dietary intake, and physical activity levels were assessed before and after the intervention.ResultsNo significant changes were observed in cardiovascular risk factors, food intake, or physical activity levels. Fecal SCFA concentrations and alpha/beta diversity also remained stable. Exploratory taxonomic analyses nevertheless identified distinct relative-abundance patterns across groups and time, including a numerical increase in the Firmicutes-to-Bacteroidota (F/B) ratio in LWWL and different trajectories of several SCFA-associated genera. Among these, Blautia and Parasutterella increased, whereas Butyricimonas, Coprococcus, and Odoribacter decreased from pre- to post-intervention in LWWL, with different trajectories observed in CG across these genera.ConclusionsThese findings suggest that taxonomic features of the gut microbiota may show compositional variation following a lifestyle intervention even in the absence of detectable changes in the measured cardiometabolic or behavioral outcomes. However, the functional and clinical significance of these exploratory taxonomic patterns remains uncertain and warrants further investigation.

BackgroundRandomized clinical trials support drug development and uptake of new therapies for systemic lupus erythematosus (SLE). However, challenges to conducting high-quality clinical trials have been noted, including underrepresentation of minoritized populations. Currently, it is not known whether the methodological quality of clinical trials is associated with representativeness of US patients with SLE.MethodsFor this cross-sectional study, we identified industry-sponsored clinical trials of small molecules and biologics for SLE with at least one US enrollment site, with results published in peer-reviewed journals as of January 1, 2026. Trial characteristics were abstracted, and urbanicity of US enrollment sites were classified using the National Center for Health Statistics Urban-Rural Classification System. Trial representativeness by sex, race, and ethnicity were assessed against SLE prevalence in meta-analyzed US lupus registries using participation-to-prevalence ratios (PPRs; ≥0.8 indicating adequate representation). Trial methodological quality was assessed using the Cochrane Risk of Bias 2 tool. Associations between trial risk of bias and representativeness were evaluated.FindingsWe identified 51 trials enrolling 18,466 participants with SLE. Trial representation was adequate for female (median PPR 1 · 03), Hispanic (median PPR 1 · 37), White (median PPR 1 · 03), and Asian participants (median PPR 2 · 40), and Black participants were underrepresented (median PPR 0 · 32). Most US enrollment sites were located in large metropolitan areas. The methodological quality of trials varied (37% at low risk of bias, 35% with some concerns, 27% at high risk of bias) but was not associated with demographic or geographic representativeness.InterpretationWe identified inconsistencies in participant representation and methodological quality across SLE clinical trials. Although trial designs were generally rigorous, limitations of participant inclusion and enrollment site distribution suggest that representation, rather than methodological quality alone, may limit the external validity of SLE clinical trials.

ObjectivesSocial determinants of health (SDOH) and race are associated with disease activity, including lower achievement of the low lupus disease activity state (LLDAS), but it is unknown whether these factors are associated with patient-reported outcomes (PROs). Among a cohort with childhood-onset systemic lupus erythematosus (cSLE) in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry, we investigated associations between race, SDOH, and PROs.MethodsIn this cSLE cohort study, the primary exposure was self-reported race and ethnicity with collected SDOH including insurance status and area deprivation index (ADI). Our primary outcomes were any functional disability by CHAQ (>0) and overall health by PROMIS Global Health-7 across follow-up. Multivariable regression models assessed these associations, adjusting for demographic and disease-related factors.ResultsAmong 540 children with cSLE, most had CHAQ (86%) and PROMIS Global Health-7 (74%) scores collected at Registry enrollment. Functional disability was common (46%), and overall health was below average (median T score 38.8, IQR 34.0-42.1) at enrollment. In unadjusted and adjusted analyses, race, insurance, and ADI were not significantly associated with either outcome. However, PROMIS completion differed significantly by race (p < 0.001).ConclusionsChildren with cSLE in the CARRA Registry commonly report deficits in functional status and overall health. Although race and SDOH were not significantly associated with PROs, differential PROMIS completion by race suggests the potential for bias in these estimates. Interventions to improve completeness and representativeness of PRO data collection are needed to support accurate assessment of health disparities in cSLE across all patient groups.

ObjectiveThis study aimed to identify novel serum biomarkers for lupus nephritis (LN) and evaluate their potential for improving diagnosis, monitoring disease activity, and understanding LN pathogenesis.MethodsA cell adhesion molecules (CAMs) antibody microarray was utilized to identify potential biomarkers of LN using serum samples from LN, chronic kidney disease (CKD), and healthy controls (HC). Differential expression analysis and LASSO regression identified CAM biomarkers in a discovery cohort, followed by ELISA validation in an independent, discovery cohort. Biomarker correlations with clinicopathological parameters were assessed, and receiver operating characteristic (ROC) analyses were performed to examine the potential diagnostic utility.ResultsOf the 17 CAMs analyzed, serum NrCAM and P-Cadherin emerged as the most promising new biomarkers, significantly discriminating LN from HC. Serum NrCAM was found to differentiate between LN and HC (p < 0.0001) as well as active LN (LNA) from inactive LN (LNI) (p < 0.01) in the discovery cohort. Serum P-Cadherin, however, differentiated LN from both HC (p < 0.0001) and CKD (p < 0.001) and distinguished LNA from LNI (p < 0.01). In a larger validation cohort, ROC analyses demonstrated strong diagnostic potential for both biomarkers, with AUC values of 0.92 and 0.82 for serum NrCAM and P-Cadherin, respectively. Significant correlations with SLEDAI, rSLEDAI, and histological indices further underscored their potential relevance to LN severity and activity. Interestingly, serum NrCAM and P-Cadherin are complementary in reflecting renal pathology changes including endocapillary hypercellularity, cellular crescents, glomerulosclerosis, tubular atrophy, and interstitial fibrosis.ConclusionSerum NrCAM and P-Cadherin show promise as non-invasive biomarkers for LN, offering potential utility in diagnosis and disease monitoring. Their ability to distinguish between disease states and correlate with clinical parameters highlights their potential to improve patient stratification and guide personalized treatment approaches in LN.

BackgroundWomen with antiphospholipid antibodies (aPL) and antiphospholipid syndrome (APS) are at increased risk of pregnancy complications. Routinely reported endpoints primarily captures what happens medically but provide limited insight into the experience of the emotional, psychosocial and lived burden of pregnancy planning and pregnancy after loss with aPL/APS. Understanding these aspects is important for patient-centered counselling, supporting adherence and wellbeing and designing future patient-centered care.ObjectivesTo explore how women with aPL/APS experience family planning, pregnancy and pregnancy care including interactions with healthcare professionals and, how living with aPL/APS affects their psychological wellbeing and quality of life.MethodsWe conducted a scoping review of medical and psychology databases to identify qualitative studies and mixed-methods studies with extractable qualitative data. We conducted a thematic analysis to synthesize findings into overarching themes.ResultsWe included six studies (114 women) across four countries. Six overarching themes were identified:1) Regaining control under perceived high risk; 2) reconfiguring family planning in light of APS; 3) living with chronic uncertainty, grief and last-chance pregnancy; 4) social and relational influences on reproductive decision-making; 5) gaps in recognition, information and monitoring and 6) the value of empathic, coordinated, multidisciplinary preconception care. Overall, women's experiences were shaped by reproductive risk, prior pregnancy loss, treatment burden, uncertainty and the quality and continuity of communication with health-care professionals.ConclusionWomen with aPL and APS are at increased risk of adverse pregnancy outcomes. While conventional clinical endpoints typically describe medical outcomes, they may provide limited insights into the emotional, psychosocial and lived burden of pregnancy planning and pregnancy. Understanding these dimensions is important for patient-centered counselling, adherence, wellbeing and the development of future care.

PurposeTargeted biologic therapy has changed the management of systemic lupus erythematosus (SLE), including lupus nephritis (LN), but incomplete response, relapse, glucocorticoid dependence, and refractory organ disease remain common. This article discusses whether bispecific and trispecific antibodies may help move lupus therapy beyond conventional monospecific blockade.Key MessagesMultispecific antibodies are not a single therapeutic class. Their clinical relevance depends on mechanism: dual-pathway blockade, interruption of B-T-cell collaboration, inhibitory non-depleting B-cell silencing, T-cell engager-mediated depletion of B-cell or plasma-cell compartments, and future trispecific immune-reprogramming concepts. Direct lupus evidence remains limited. Obexelimab, which co-engages CD19 and the inhibitory receptor FcγRIIb, provides the most informative randomised SLE dataset, but its phase 2 trial did not meet the primary endpoint and biomarker-defined signals remain hypothesis-generating. Teclistamab, a BCMA × CD3 T-cell engager, offers a provocative single-case proof of concept in refractory SLE with active LN, but also illustrates risks of cytokine release syndrome, infections, and hypogammaglobulinaemia. Rozibafusp alfa, which targets ICOSL and BAFF, illustrates the biological appeal, and clinical difficulty, of rational dual-pathway blockade in SLE.ConclusionsMultispecific antibodies may become useful in lupus if their depth of immune intervention can be matched to disease phenotype, safety risk, and trial design. Their future role will depend on lupus-specific evidence, biomarker-guided selection, and careful positioning between conventional biologics and cellular immune-reprogramming strategies.

ObjectiveInfection is a major factor in morbidity and mortality among pediatric systemic lupus erythematosus (SLE) patients, particularly opportunistic infections (OI), which can result in severe clinical outcomes. There is a scarcity of data regarding OI in children with SLE in resource-limited areas. This study aimed to determine the incidence of OI in childhood SLE, describe their characteristics, and identify associated risk factors.MethodsThis study is a retrospective and prospective study from January 2009 to November 2025 at King Chulalongkorn Memorial Hospital, Thailand. Data on demographics, clinical features, laboratory parameters, types of OI, and outcomes were analyzed. Conditional logistic regression analysis was used to identify risk factors for OI in pediatric SLE.ResultsAmong 177 children with SLE, 38 patients developed OI. Person-year incidence of OI was 3.4 per 100 person-year (95% CI: 2.3-4.9). The most common OIs were Candida spp. (27.0%), Aspergillus spp. (13.5%), and Cytomegalovirus (CMV) (13.5%) with respiratory and mucocutaneous sites being the most frequently affected. Pulse intravenous methylprednisolone (IVMP) use during the past 3 months and high disease activity, defined as SLEDAI-2K score ≥ 11, were associated with an increased risk of OI in the multivariate model (adjusted OR, aOR 16.12; 95% CI 3.42-75.85 and aOR 3.46; 95% CI 1.44-8.31, respectively). Other variables, including cumulative prednisolone dose, cumulative cyclophosphamide exposure, complement 3 (C3) and C4 level, absolute lymphocyte count, and serum albumin, were not significantly associated with OI development after adjustment for potential confounders.ConclusionFungal and CMV infections were common OI in pediatric SLE. This finding underscores the importance of clinical vigilance regarding OI and the implementation of preventive strategies in SLE patients with the recent pulse IVMP exposure or high disease activity.