Objective. To test the interrater reliability of the revised British Isles Lupus Assessment Group 2004 (BILAG-2004) index for the assessment of systemic lupus erythematosus (SLE) activity.Methods. Patients with SLE were recruited from 11 centers. Two physician raters separately assessed the patients' disease activity using the BILAG-2004 index in routine clinical practice. Scores ranged from A (for very active disease) to E (for inactivity). Two reliability exercises were performed. Changes were made to the index after the first exercise (E1), and additional training was provided to the raters before the second exercise (E2). E1 and E2 involved 12 and 14 raters, respectively. Interrater reliability was assessed using kappa statistics and intraclass correlation coefficients. Levels of agreement and the extent of major disagreement were also examined. Major disagreement was defined as a score difference between raters of A versus C, D, or E or B versus D or E.Results. For each exercise, 97 patients were recruited. In E1, the mean age of the patients was 42.3 years (range 18.5-82.2 years), 89.7% were women, and 74.2% were white, 8.2% were Afro-Caribbean, and 13.4% were South Asian, and in E2, the mean age was 43.7 years (range 17.7-75 years), 90.7% were women, and 68% were white, 15.5% were Afro-Caribbean, and 11.3% were South Asian. The mean disease duration was 9.4 years (range 0-32.1 years) for patients in E1 and 10 years (range 0-34.8 years) in E2. There was improvement in the interrater reliability and the level of agreement from E1 to E2. Further improvement was achieved after removal of poorly performing items.Conclusion. The BILAG-2004 index is a reliable tool to assess SLE activity. The use of a well-defined glossary and training of raters are essential to ensure the optimal performance of the index.Systemic lupus erythematosus (SLE) is a complex, multisystem autoimmune disease with a myriad of immunologic and clinical manifestations. In fact, any organ system can be affected. Currently, no single biomarker that would accurately reflect disease activity in SLE has been identified. As a result, numerous composite clinical indices have been developed to stan-

Objective: To investigate the atherosclerosis hypothesis in primary antiphospholipid syndrome (PAPS). Methods: The intima media thickness (IMT) of carotid arteries and other cardiovascular risk factors was measured in 20 patients with PAPS (mean (SD) age 35 (12) years) and in 20 controls matched for age and sex (34 (12) years). Results: The frequency of smoking, hypertension, and dyslipidaemia was similar in the two groups, but plasma homocysteine was higher in patients with PAPS (mean (SD) 11.9 (6.2) v 8.2 (3.4) mmol/l, p = 0.037). The IMT was slightly greater in patients with PAPS than in controls at the carotid bifurcation (mean (

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Objective. To establish a mathematical model to predict the probability of symmetry of joint involvement as a function of the number of joints involved and to compare expected with actual probabilities in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) and in early and late disease.Methods. Random involvement of joints was assumed, and the binomial theorem was used to give the frequency distribution of involved joints as a function of each joint count. Ten joint pairs were included: shoulder, elbow, wrist, metacarpophalangeal joints, proximal interphalangeal (PIP) joints of the hands, hip, knee, ankle, metatarsophalangeal joints, and PIP joints of the feet. Observed probabilities were obtained from subjects with early (duration <12 months) and late PsA and RA.Results. The number of subjects in each of the disease subgroups was as follows: early PsA n ‫؍‬ 33, late PsA n ‫؍‬ 77, early RA n ‫؍‬ 61, late RA n ‫؍‬ 93. Observed probabilities of symmetry exceeded predicted probabilities for all disease subgroups. The median number of involved joints in each group was as follows: early PsA 4, late PsA 8, early RA 8, late RA 15 ( 2 ‫؍‬ 95.3, 3 degrees of freedom, P ‫؍‬ 0.0001, by Kruskal-Wallis test). After correcting for the discrepancy in the number of involved joints, no difference in joint symmetry was found between the groups ( 2 ‫؍‬ 1.77, P ‫؍‬ 0.62 by Friedman two-way analysis of variance). Similar results were obtained when individual hand and foot joints were analyzed separately.Conclusion. The pattern of joint involvement is often used to distinguish between rheumatoid and psoriatic arthritis. This study confirms that symmetry is largely a function of the total number of joints involved and that, in terms of joint pattern, differences between these disorders are more quantitative than qualitative. Both disorders have high absolute values of symmetry, particularly in the joints of the wrist and hand.