Significant weight loss is achievable over 6 weeks in a diet-specific trial in subjects with stable SLE, who are on low dose prednisolone. Both diets were equally tolerable, and did not cause flares in disease activity. Our results suggest that dietary manipulation may significantly improve fatigue in subjects with SLE.

Rituximab therapy achieved a response in 13/18 patients with refractory LN. However, in patients with rapidly progressive crescentic LN, when there is already evidence of significant renal impairment, rituximab therapy may not prevent progression to ESRF and dialysis. Our data also suggest that severe Class IV-G LN may be associated with a poor response to therapy.

The antiphospholipid (Hughes) syndrome (APS) is characterized by recurrent arterial or venous thromboembolism, or pregnancy loss, in association with antiphospholipid antibodies. These antibodies may be associated with premature or accelerated atherosclerosis and emerging evidence supports the concept of a vasculopathy in the APS that may lead to arterial stenotic lesions, possibly contributing to vascular occlusions and pregnancy morbidity.

Ninety-five lupus nephritis patients had paired results and were included in the final analysis, male/female 14/81, mean age 36.5 years. Over a three-year period there were a total of 137 samples from 95 patients. For the entire dataset, there was a significant correlation between protein:creatinine ratio and 24-h urine collection protein (mg), Spearman Rho correlation coefficient was 0.869, p < 0.0001 with (R (2 )= 0.504). There was also a strong correlation for longitudinal data, n = 14 at two-years Rho 0.910, p < 0.0001 with (R (2 )= 0.878), n = 8 at three-years Rho 0.909, p < 0.0001 and (R (2 )= 0.73). We have shown for the first time in a UK population of lupus nephritis patients, well trained in producing 24-h collection, that the spot protein:creatinine ratio correlates well with 24-h urinary total protein excretion. Having a simple, reliable, reproducible and cost-effective test such as the spot urine protein:creatinine ratio is therefore a valuable tool with which to monitor disease progression.

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Systemic lupus erythematosus (SLE) patients currently are exposed to a number of agents to control various manifestations of their disease. In particular the degree of immunosuppression employed is strongly related to the underlying disease severity. This causes problems when evaluating the longterm associations between drugs and outcomes such as cardiovascular disease. Nevertheless, most studies do suggest that increased and prolonged exposure to steroids is harmful to the vasculature and that antimalarial drugs may have several potential beneficial effects in reducing CHD risk in SLE. Further work is now needed to assess if there are doses or regimes of steroid therapy that can optimize their anti-inflammatory effects and minimise their adverse metabolic effects. With regard to other drugs used, it should not be assumed that all immunosuppressive drugs are equal with regard to the cardiovascular system. There is some emerging data that azathioprine may have an association with atherosclerosis development. Whether this is independent of the clinical phenotype remains an open question. Studies of MTX in RA are controversial and in SLE the specific cardiovascular effects of MTX requires direct study.With several novel agents currently in development, their potential effects on the vasculature need specific study to unravel the relative effects of the inflammatory burden, specific organ involvement and therapy on vascular risk. Lupus (2006) 15, 23-26.