Objective To evaluate rheumatoid arthritis (RA) and mortality risk among women followed prospectively in the Nurses’ Health Study (NHS). Methods We analyzed 119,209 women in the NHS who reported no connective tissue disease at enrollment in 1976. Comorbidity and lifestyle data were collected through biennial questionnaires. Incident RA cases were validated by medical records review. Cause of death was determined by death certificate and medical records review. Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause, cardiovascular disease (CVD), cancer, and respiratory disease mortality for women with RA compared to those without RA. Results We validated 964 incident RA cases and identified 28,808 deaths during 36 years of prospective follow-up. Of 307 deaths among women with RA, 80 (26%) were from cancer, 70 (23%) were from CVD, and 44 (14%) were from respiratory causes. Women with RA had increased total mortality (HR 1.40, 95% CI 1.25–1.57) compared to those without RA, independent of mortality risk factors, including smoking. RA was associated with significantly increased respiratory disease mortality (HR 2.06, 95% CI 1.51–2.80) and cardiovascular disease mortality (HR 1.45, 95% CI 1.14–1.83), but not cancer mortality (HR 0.93, 95% CI 0.74–1.15). For women with seropositive RA, respiratory disease mortality was nearly 3-fold higher than among non-RA women (HR 2.67, 95% CI 1.89–3.77). Conclusion Women with RA had significantly increased mortality compared to those without RA. Respiratory disease and cardiovascular disease mortality were both significantly elevated for women with RA. The nearly 3-fold increased relative risk of respiratory disease mortality was observed only for those with seropositive RA.

Objective To identify factors associated with development of systemic lupus erythematosus (SLE) among patients evaluated at a tertiary care Lupus Center for potential SLE Methods We identified patients first seen at the Brigham and Women's Hospital Lupus Center between January 1, 1992 and December 31, 2012 and thought to have potential SLE by a board certified rheumatologist. All had 1-3 SLE ACR criteria at initial visit and >2 follow-up visits ≥ 3 months apart. We reviewed medical records through May 15, 2013 for: SLE signs and symptoms, autoimmune serologies, prescriptions, and diagnoses by board certified rheumatologists. Bivariable analyses and multivariable logistic regression models were used to identify independent predictors of developing SLE. Results 264 patients met inclusion criteria. At initial visit, mean age was 39.2 (SD 12.4) years, 94% were female and 67% white. Mean number of SLE ACR criteria was 2.7 (SD 1.0) and 88% were antinuclear antibody (ANA) positive at initial consultation. Mean follow-up time was 6.3 (SD 4.3) years and 67% were prescribed hydroxychloroquine in follow-up. At most recent visit, 56 (21%) had been diagnosed with SLE; 47 (18%) were thought not to have SLE; and 161 (61%) were still considered to have potential SLE. In multivariable regression models, oral ulcers (OR 2.40, 95%CI 1.03-5.58), anti-dsDNA (OR 2.59, 95% CI 1.25-5.35) and baseline proteinuria or cellular casts (OR 16.20, 95%CI 1.63-161.02) were independent predictors of developing SLE. The most common other final diagnoses included fibromyalgia, Sjögren's syndrome, mixed connective tissue disease and cutaneous lupus. Conclusion Among patients with potential SLE at initial consultation, 21% were diagnosed with definite SLE within 6.3 years. Oral ulcers, anti-dsDNA and proteinuria or cellular casts were independent predictors of developing definite SLE. A better means of accurately identifying those who will develop SLE among those presenting with potential disease is necessary.

BACKGROUND Systemic lupus erythematosus (SLE) is a disease of reproductive-age women and thus questions regarding how disease influences pregnancy outcomes arise. We investigated whether five specific types of SLE activity during the six months before conception or during pregnancy (nephritis, cytopenias, skin disease, arthritis, serositis) were associated with adverse pregnancy outcomes. METHODS We performed a retrospective cohort study of pregnancy outcomes among women with SLE at the Brigham and Women's Hospital Lupus Center. Adverse pregnancy outcomes included pre-eclampsia, preterm delivery, elective termination due to SLE, spontaneous miscarriage at weeks 12–20, and stillbirth. SLE and obstetric history, laboratories, and medications were obtained from electronic medical records. Generalized linear mixed models adjusting for potential confounders were used to identify predictors of any adverse pregnancy outcome. RESULTS Most pregnancies resulted in a live, term delivery (76.5%). After adjustment for Hispanic ethnicity, prior adverse pregnancy outcome and medication use six months before conception, nephritis during pregnancy (OR 3.6, 95% CI [1.0–12.8]), cytopenias during pregnancy (OR 3.9, 95% CI [1.3–11.4]), and serositis during pregnancy (OR 5.9, 95%CI [1.0–34.0]) were significantly associated with adverse pregnancy outcome. CONCLUSIONS Specific types of SLE disease activity during pregnancy were related to adverse pregnancy outcome. Nephritis, cytopenias and serositis carried a higher risk of adverse pregnancy outcome, suggesting that these abnormalities should be carefully monitored during pregnancy.