[LBT]). In patients with low serum complement levels, 91% had a positive LBT), as compared with 15% in those with normal complement levels. The LBT was positive in 70% of patients with clinical and laboratory evidence of renal disease, but in only 31% of patients without renal disease. 81% of patients with the more severe histologic forms of lupus nephritis, i.e., proliferative glomerulonephritis and membranous glomerulonephritis, had positive tests, whereas only 23% with mesangial glomerulitis or normal histologic findings were positive. Immunoglobulins of the same class found in the skin were detected in the glomeruli of patients examined by renal biopsy. These results suggest that there is a relationship between the occurrence of immunoglobulin in the epidermal basement membrane and the presence of the more severe forms of lupus nephritis.

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Thirty women with systemic lupus erythematosus were categorized into groups with and without significant renal involvement on the basis of renal biopsy and subsequently followed for an average of 9.4 years. At this time 53% of the patients with renal disease and 70% of the "nonrenal" patients had died. While 80% of the deaths in the "renal" group were due to renal disease, none of the nonrenal patients died of this complication. Major central nervous system involvement was eventually noted in 100% of the nonrenal group. After 8.3 years, mortality in the nonrenal patients exceeded that in the renal group, mainly because of the emergence of central nervous system disease.Although a number of reports have dealt with the renal involvement (1 -8) and long-term prognosis (3, 5, 6, 9-1 1) of patients with systemic lupus erythematosus (SLE), there has been a paucity of data concerning the ultimate prognosis of patients without significant renal involvement ( 5 , 7 , 8,10). In the present study a group of SLE patients has been classified ac- cording to their renal histology, and their rlinical course documented over a prolonged followup period which averaged 9.4 years. MATERIALS AND METHODSThis prospective study was conducted among patients admitted to Parkland Memorial Hospital during the years [1960][1961][1962][1963][1964][1965][1966][1967]. During this interval, 48 patients with SLE were hospitalized one or more times; all fulfilled the diagnostic criteria of the American Rheumatism Association (12). Ropes (13), and the British Medical Research Council (14) for SLE. Of the 48 patients, 30 females (21 black, 6 white, 3 Latin American: mean age 30.8 years, range 8 to 63 years) were included in the study on the basis of availability of a renal biopsy on admission and continued attendance in the outpatient clinic. Biopsies were performed without regard to the presence or absence of clinical evidence of renal disease. The date of onset of SLE was arbitrarily chosen as the time when the patient was first hospitalized with definite symptoms of SLE. All patients seen in the Arthritis Clinic with SLE were hospitalized one or more times during the period of the study. Admissions to the study were closed in 1967, and the patients were followed in the outpatient clinic by their respective physicians until January 1972, when all records were reviewed. The mean follow-up period was 9.4 years, ranging from 11 months, when death intervened in 1 case, to 15.5 years.Although cyclophosphamide and 6-mercaptopurine were used in 9 of the 30 patients studied, these were administered merely as an adjunct to steroid therapy and only in the final 670

Sera of 50 patients with systemic lupus erythematosus (SLE) were examined for the presence of hepatitis B antigen (HBAg) and antibody (HBAb) by radioimmunoassay (RIA). All single serum specimens from 48 patients examined by the basic double-antibody method for HBAg gave negative results. The "heated" double-antibody technique, which detects HBAg in the presence of HBAb or other heat-labile interfering factors, was also negative. When 151 sera from the 50 patients with SLE were tested for HBAg using solid-phase RIA, a positive reaction was observed in only one specimen. The specificity of the reaction for HBAg in this serum was confirmed. Three other serum specimens subsequently obtained from the patient were HBAg negative. The prevalence and titers of hepatitis B antibody detected by RIA among 48 of the patients with SLE were similar to those observed among healthy blood donors. No special relationship between hepatitis B virus and systemic lupus erythematosus was demonstrated.Recent reports have disagreed widely on the frequency with which hepatitis B antigen (HBAg; Australia Antigen) is found in the serum of patients with systemic lupus erythematosus (SLE). Using a complement fixation test, Alarc6n-Segovia (1) HBAg in at least one serum specimen from 79 (75%) of 116 patients with SLE. Ziegenfuss (2) tested mercaptoethanol-treated sera by a modified counterelectrophoresis (CEP) technique and found HBAg in 9 of 17 (47%) patients. I n contrast, Panush et al (3) found that all sera of 100 patients with SLE were HBAg-negative by CEP.These studies employed relatively insensitive HBAg-testing methods. I n the present investigation two highly sensitive radioimmunoassay (RIA) techniques-ie, a double-antibody method employing human antiserum against HBAg (4) and a commercial solid-phase method using guinea pig antibody (5)-were used in testing multiple serum samples from 50 patients with welldocumented SLE. T o obtain further information about previous exposure of these patients to hepatitis B virus, sera from 48 of the patients were tested for antibody to HBAg (HBAb), also by RIA.

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FIGURE 1. Acute arthritis in the right knee of the patient. Significant swelling of the right knee also involved the quadriceps area.