We assessed whether quantitative analysis of Doppler flow velocity waveforms is able to identify subclinical microvascular abnormalities in SLE and whether eigenvector analysis can detect changes not detectable using the resistive index (RI). Fifty-four SLE patients with no conventional cardiovascular risk factors, major organ involvement or retinopathy were compared to 32 controls. Flow velocity waveforms were obtained from the ophthalmic artery (OA), central retinal artery (CRA) and common carotid artery (CA). The waveforms were analysed using eigenvector decomposition and compared between groups at each arterial site. The RI was also determined. The RI was comparable between groups. In the OA and CRA, there were significant differences in the lower frequency sinusoidal components (P < 0.05 for each component). No differences were apparent in the CA between groups. Eigenvector analysis of Doppler flow waveforms, recorded in proximity of the terminal vascular bed, identified altered ocular microvascular haemodynamics in SLE. Altered waveform structure could not be identified by changes in RI, the traditional measure of downstream vascular resistance. This analytical approach to waveform analysis is more sensitive in detecting preclinical microvascular abnormalities in SLE. It may hold potential as a useful tool for assessing disease activity, response to treatment, and predicting future vascular complications.

Systemic lupus erythematosus (SLE) is a complex autoimmune disease with no known cure and an unclear etiology. Patients often suffer from photosensitivity and for this reason are advised to stay out of direct sunlight and to wear a sun protection factor (SPF) of ‡ 15. Approximately 98 % of vitamin D synthesis in the skin is blocked by a SPF of 15 (1) ; therefore, individuals with SLE may be at greater risk of vitamin D deficiency. Vitamin D in its hormonally-active form has immunoregulatory properties and may impinge on the pathology of autoimmune diseases (2) . The objectives of the present study were to assess vitamin D status in patients with SLE in comparison with age-and gender-matched controls and to compare dietary vitamin D intake and status with disease activity in SLE.Patients with SLE were recruited between December 2005 and February 2006 as part of a larger study (3) . Control volunteers were recruited from University of Ulster staff. Vitamin D intakes were estimated from 4 d food diaries and vitamin D status was assessed by measuring plasma 25-hydroxyvitamin D (25(OH)D) using the OCTEIA 25(OH)D enzyme immunoassay (Immunodiagnostic Systems Ltd, Boldon, Tyne and Wear, UK). Disease activity was measured using the revised systemic lupus activity measure (SLAM-R) (4) . Mean dietary vitamin D intakes for the SLE (n 19) and control (n 19) groups were 2.8 (SD 2.6) mg and 2.2 (SD 1.3) mg respectively. Results from an independent t-test indicated individuals with SLE had significantly higher serum 25(OH)D (70.6 (SD 37.3) nmol/l) than controls (56.0 (SD 18.5) nmol/l; P = 0.022) with 32 % and 44 % of SLE and controls with suboptimal levels ( < 50 nmol/l) respectively. Mean SLAM-R score for those with SLE was 9.1 (SD 3.8). Analysis revealed a significant negative correlation between dietary vitamin D intake and SLAM-R (r 0.657, P = 0.006) and a significant positive correlation between vitamin D status and SLAM-R (r 0.539, P = 0.017).In conclusion, intake of vitamin D in both patients with SLE and controls was inadequate and inadequate intake was related to greater disease activity in the patients with SLE. The positive correlation reported between serum 25(OH)D and disease activity in SLE may be as a result of those patients with more active disease receiving steroidal treatment. Steroids are routinely administered in conjunction with vitamin D and Ca and the level of serum 25(OH)D in SLE would support vitamin D supplementation use. These results are preliminary findings and further investigation is required to elucidate the role of vitamin D in SLE.

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Background: Osteoporotic fractures and falls are as heads and tails of a coin. Among the elderly, the greatest risk of fracture comes from falls, rather than osteoporosis, hence, bone mineral density measurement should not be used alone to estimate fracture risk or guide treatment decisions. Evidence shows that at least 15% of falls in older people can be prevented, with individual trials reporting relative reductions of up to 50%. We developed a model that predicts the falls risk among patients referred for bone mineral density using variables that are easily assessed in clinical practice. Methods: As part of the integrated osteoporosis and falls service, patients admitted to the hospital with low trauma fracture had their bone mineral density assessed. In addition to DXA scanning, fracture risk assessment using FRAX (before and after the occurrence of the fracture), as well as falls risk factors were analyzed. The independent predictive value of the different risk factors for the occurrence of falls was assessed using logistic regression analysis. A prediction scoring system was developed using data from a cohort of 106 patients. 102 osteoporotic patients without history of falls or fracture were also assessed as control group. The diagnostic performance of the prediction model was evaluated using the area under the curve (AUC). The developed prediction model was internally validated. Results: Falls risk was significantly higher among the osteoporotic patients who sustained fractures in comparison to the control group (P < 0.01). The risk factors significantly correlated with an increased risk of falls were: history of > 1 fall in the last 12 months (regression coefficient 2.2), slowing of the walking speed/ change of the gait (1.6), impaired vision (1.2), weak grip strength (1.1), loss of balance (1.2). Cut off point of 3.5 achieved the best sensitivity and specificity (0.918 and 0.86 respectively, PPV85.9) and was indicative of high falls risk. A score of 2.0-3.5 was indicative of moderate risk. Conclusions: The findings indicate that evaluation of falls risk based on risk factor profiles of individual patients can help physicians identify high risk osteoporotic patients and assist with decisions concerning falls prevention and patient management. Also, these results emphasize the importance of performing a falls risk assessment for all osteoporotic patients, in parallel with bone mineral density measurement, on regular basis as part of their assessment and management.