Objective. To determine the frequency of musculoskeletal system damage among patients in the Hopkins Lupus Cohort, over time, and to determine predictors of musculoskeletal damage (including avascular necrosis of bone, osteoporosis, and fracture) in the same cohort.Methods. Evaluation of the cohort visit database [from 1989 or at the time of entry into the cohort if later than 1989) for the 407 patients with systemic lupus erythematosus (SLE). Musculoskeletal damage was measured by the SLICC/ACR Damage Index.Results. Total damage and musculoskeletal damage accumulated from the time of diagnosis of SLE, and musculoskeletal damage continued over time, with avascular necrosis of bone being the most common form. African-Americans and SLE patients of lower socioeconomic status were more likely to experience musculoskeletal damage. Use of corticosteroids was a major risk factor for both avascular necrosis of bone and osteoporosis.Conclusion. Musculoskeletal damage remains one of the major sequela of SLE. Reduction of the modi-

Objective. To determine the short-term outcome of neuropsychiatric (NP) events upon enrollment into an international inception cohort of patients with systemic lupus erythematosus (SLE).Methods. The study was performed by the Systemic Lupus International Collaborating Clinics. Patients were enrolled within 15 months of SLE diagnosis and NP events were characterized using the American College of Rheumatology case definitions. Decision rules were derived to identify NP events attributable to SLE. Physician outcome scores of NP events and patient-derived mental component summary (MCS) and physical component summary (PCS) scores of the Short Form 36 were recorded. Results. There were 890 patients (88.7% female) with a mean ؎ SD age of 33.8 ؎ 13.4 years and mean disease duration of 5.3 ؎ 4.2 months. Within the enrollment window, 271 (33.5%) of 890 patients had at least 1 NP event encompassing 15 NP syndromes. NP events attributed to SLE varied from 16.5% to 33.9% using alternate attribution models and occurred in 6.0 -11.5% of patients. Outcome scores for NP events attributed to SLE were significantly better than for NP events due to non-SLE causes. Higher global disease activity was associated with worse outcomes. MCS scores were lower in patients with NP events, regardless of attribution, and were also lower in patients with diffuse and central NP events. There was a significant association between physician outcome scores and patient MCS scores only for NP events attributed to SLE. Conclusion. In SLE patients, the short-term outcome of NP events is determined by both the characteristics and attribution of the events.

Deficiencies of MBP predispose individuals to SLE.