The acetylation rate of sulfamethazine was studied in 25 patients with systemic lupus erythematosus (SLE). Seventeen of 25 SLE patients, 6896, were slow acetylators compared to the reported incidence of 52% in the general population. There was no correlation between the acetylator phenotype in SLE patients and the various clinical manifestations or the activity of the disease. Lupus patients who were slow acetylators had a lower lymphocyte response to phytomitogens compared to rapid acetylators.Following the administration of certain drugs, a number of patients develop a disease which presents many of the clinical and laboratory characteristics of systemic lupus erythematosus (SLE). The drugs most clearly associated with this lupus-like syndrome are hydralazine, procainamide, anticonvulsants, and isoniazid (1 ). Prolonged therapy with hydralazine, a frequently used antihypertensive agent, induces antinuclear factors (ANF) in 54% of patients (2). Approximately 12% of

Nine of 86 patients with systemic lupus erythematosus (SLE) were diagnosed after the age of sixty. They differ from younger patients with SLE in mode of onset, specific organ systems involved, severity of disease, and prognosis. The presentation in the elderly is insidious rather than acute. Most patients initially show a polymyalgia rheumatica syndrome or rheumatoid-like arthritis. The clinical course is benign, serositis is less common, the patients are more easily controlled on aspirin or low-dose steroids, and the progress of SLE in the elderly is relatively slow. Because age modifies the clinical expression of SLE the diagnosis in the elderly can be easily missed if not specifically searched for.The onset of systemic lupus er¬ ythematosus (SLE) is uncommon over the age of 60.1-' Eighteen of 520 patients with SLE described by Du¬ bois1 and five of 105 patients de¬ scribed by Harvey et al2 were older than 60 years of age. Of 299 patients reported by Kellum and Haserick,' nineteen were over the age of 60. This paper reports the clinical and serological findings of nine white patients in whom the diagnosis of systemic lupus erythematosus was first documented after the age of 60. These patients differ from younger patients with SLE in mode of onset, specific organ systems involved, severity of disease, and prognosis. Methods

Twenty-seven hypertensive patients (23 of whom were black) were treated with hydralazine as their major antihypertensive drug and were followed for evidence of autoimmunity and clinical systemic lupus erythematosus (SLE). Only one patient developed SLE but many, although asymptomatic, had serologic evidence of autoimmunity: antibodies to single- and double-stranded ribonucleic acid (RNA), single-stranded deoxyribonucleic acid (DNA), histones, and lymphocytes. Acetylation phenotype profoundly influenced this response; slow acetylators had a higher incidence and larger amounts of autoantibodies. Antibodies to both types of RNA were a more sensitive index of autoimmunity than antinuclear antibodies. Hydralazine treatment did not alter cell-mediated immune responses. The hydralazine SLE patient had large amounts of autoantibodies that were predominantly IgG, while in the others IgM autoantibodies were predominant. No antibodies, but positive lymphoproliferative responses to hydralazine, were found in half the patients tested.

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