Females are more susceptible than males to many autoimmune diseases. The processes causing this phenomenon are incompletely understood. Here, we demonstrate that aged female mice acquire a previously uncharacterized population of B cells that we call age-associated B cells (ABCs) and that these cells express integrin ␣ X chain (CD11c). This unexpected population also appears in young lupus-

Results. Between diagnosis and followup interview, the proportion employed declined from 74% to 54%. Over the same period, hours of work per year declined by 32.2% among all individuals with a work history, but by only 1% among those continuously employed. Among individuals working at diagnosis, the proportion employed declined by 15% and 63% after 5 and 20 years, respectively. Demographics (age, sex, and education) and work characteristics (physical and psychological demands of jobs and level of control) were the principal determinants of work loss. Conclusion. Total cessation of employment, rather than reduced hours among employed persons, accounts for most of the decline in annual work hours among persons with SLE.

Objectives To describe the clinical features of patients who presented with “idiopathic” interstitial pneumonia but who were ultimately diagnosed with anti-synthetase syndrome based on clinical features and positive anti-PL-7 or -PL-12 antibodies. Methods Over a 24 month period, in our interstitial lung disease (ILD) program, we evaluated 37 patients who presented with clinical features suggestive of anti-synthetase (AS) syndrome, negative anti-JO-1 antibodies, and who were assessed for other anti-tRNA synthetase (anti-tRS) antibodies. All data were abstracted from the medical record. Results Nine (24%) were confirmed to have non-anti-Jo-1 positive AS syndrome based on clinical features and the presence of other anti-tRS antibodies (seven with anti-PL-7 and two with anti-PL-12 antibodies). Five were women; seven were Caucasian. All nine presented with dyspnea as the initial symptom and with ILD as the first manifestation. Elevated CPK was identified in three patients (median 75, range 22–925), but only two had muscle weakness. Pulmonary physiology revealed restriction (forced vital capacity 60% of predicted) and impaired gas transfer (diffusing capacity for carbon monoxide 40% of predicted). All had similar findings on thoracic HRCT scans, with extreme basilar predominance of abnormalities and patterns suggestive of non-specific interstitial pneumonia and organizing pneumonia. Immunomodulatory therapies were used to treat the ILD—responses were variable, but some subjects clearly improved. Conclusion Anti-PL-7 and PL-12 antibodies may be more common among patients presenting with “idiopathic” interstitial pneumonia than formerly considered and should be checked in patients with features of AS syndrome despite a negative anti-nuclear or anti-JO-1 antibodies. Further research is needed to advance understanding of anti-PL-7 or anti PL-12 positive AS syndrome, including its prognosis, optimal approaches to therapy, and to determine how its course differs from other forms of ILD.

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Objective. To systematically develop a quality indicator (QI) set for systemic lupus erythematosus (SLE).Methods. We used a validated process that combined available scientific evidence and expert consensus to develop a QI set for SLE. We extracted 20 candidate indicators from a systematic literature review of clinical practice guidelines pertaining to SLE. An advisory panel revised and augmented these candidate indicators and, through 2 rounds of voting, arrived at 25 QIs. These QIs advanced to the next phase of the project, in which we employed a modification of the RAND/UCLA Appropriateness Method. A systematic review of the literature was performed for each QI, linking the proposed process of care to potential improved health outcomes. After reviewing this scientific evidence, a second interdisciplinary expert panel convened to discuss the evidence and provide final ratings on the validity and feasibility of each QI. Results. The final expert panel rated 20 QIs as both valid and feasible. Areas covered included diagnosis, general preventive strategies (e.g., vaccinations, sun avoidance counseling, and screening for cardiovascular disease), osteoporosis prevention and treatment, drug toxicity monitoring, renal disease, and reproductive health. Conclusion. We employed a rigorous multistep approach with systematic literature reviews and 2 expert panels to develop QIs for SLE. This new set of indicators provides an opportunity to assess health care quality in patients with SLE and represents an initial step toward the important goal of improving care in this patient population. INTRODUCTIONLong-term survival of patients with systemic lupus erythematosus (SLE) has improved greatly over the last several decades, but morbidity from the disease and complications of medical therapy remain important concerns. Although many studies have explored risk factors associated with poor outcomes in SLE (1-4), few studies have investigated the quality of health care received by patients with this condition (5,6). One important barrier to such research is the lack of consensus on health care processes constituting high-quality care in SLE. We aimed to address this gap by developing a quality indicator (QI) set for SLE.Over the last decade, research focusing on quality measurement in health care has burgeoned, partly in response to the initiative launched by the Institute of Medicine in 1996 to assess and improve health care quality. The Institute of Medicine defined quality as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge" (7). In the US, the most commonly used tools to measure quality have taken the form of QIs, defined as "retrospectively measurable elements of practice performance for which there is evidence or consensus that can be used to assess the qual- Arthritis & Rheumatism (Arthritis Care & Research) Vol. 61, No. 3, March 15, 2009, pp 370 -377 DOI 10.1002/art.24356 © 2009, American College ...