Lupus最新文献

{"title":"Validation and prognostic utility of SLERPI in a single-centre retrospective Central European cohort.","authors":"Andrea Zoli, Seda Nur Aydogdu, Danae-Mona Nöthling, Paraskevi Chasani, Maria Antonietta D' Agostino, Silvia Laura Bosello, Andreas Ramming, Christina Bergmann, Georg Schett, Chiu Wai Shirley Chan, Panagiotis Garantziotis","doi":"10.1177/09612033261474985","DOIUrl":"10.1177/09612033261474985","url":null,"abstract":"<p><p>ObjectivesTo evaluate the diagnostic performance of the SLE Risk Probability Index (SLERPI) in a European cohort and explore its potential prognostic utility for early flare risk stratification.MethodsThis retrospective study included 280 patients with physician-diagnosed SLE and 156 non-SLE controls from a tertiary centre. Diagnostic performance (sensitivity, specificity, and area under the curve [AUC]) of the SLERPI and the 2019 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria were assessed against physician diagnosis as the reference standard. Severe flares within 3 years of diagnosis were defined using the SELENA-SLEDAI Flare Index. Multivariable logistic regression was used to identify predictors of severe flare.ResultsSLERPI demonstrated a higher AUC than the 2019 EULAR/ACR criteria (0.967, 95% CI 0.950-0.984 vs 0.932, 95% CI 0.908-0.957; DeLong p = 0.0004) and greater specificity (97.4% vs 94.9%), whereas sensitivity (85.7% vs 87.1%) and negative predictive value (79.2% vs 80.4%) were slightly lower. Analysis of discordant classifications revealed that the SLERPI captured cutaneous-predominant presentations more effectively, while the EULAR/ACR criteria showed greater sensitivity for serositis-driven disease. Patients who developed a severe flare within 3 years had significantly higher baseline SLERPI scores (<i>p</i> = 0.047). Youden's J statistic identified a threshold of ≥10.2 points as potentially informative for severe flare risk stratification. In multivariable analysis, a model incorporating SLERPI constituent items identified proteinuria and serositis at diagnosis as independent predictors of severe flare (AUC 0.708, 95% CI 0.641-0.775); bootstrap internal validation yielded a lower, optimism-corrected AUC of 0.635 (95% CI 0.574-0.695).ConclusionSLERPI demonstrates high diagnostic accuracy in a single-centre retrospective Central European cohort. Exploratory analyses suggest that higher baseline SLERPI scores may be associated with an increased risk of early severe flares; however, these findings require external validation before prognostic use can be recommended.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"1292-1300"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the therapeutic landscape: Biologics and immunosuppressive therapy in lupus nephritis during pregnancy.","authors":"Sonja Golubović, Siniša Živković, Vladimir Veselinov, Dejan Ćelić, Milica Popović, Tatjana Ilić, Violeta Knežević","doi":"10.1177/09612033261469025","DOIUrl":"10.1177/09612033261469025","url":null,"abstract":"<p><p>BackgroundLupus nephritis (LN) predominantly affects women of reproductive age and carries substantial risks during pregnancy, including disease flare, preeclampsia, acute kidney injury, and adverse fetal outcomes. The therapeutic armamentarium for LN has expanded considerably with the approval of voclosporin, belimumab, and obinutuzumab, yet pregnancy safety data for these agents remain conspicuously absent. Concurrently, the 2024 EULAR recommendations for antirheumatic drugs in reproduction, the 2025 EULAR lupus nephritis update, and the 2024 KDIGO guidelines have reset the landscape of management guidance. This review critically appraises the evidence on the safety and clinical use of all current LN-relevant immunosuppressive and biologic therapies during pregnancy, lactation, and the periconceptional period.MethodsA comprehensive narrative review of literature published between January 2000 and May 2025 was conducted using PubMed, MEDLINE, EMBASE, and Cochrane databases. Key guidelines, pregnancy registries, and landmark clinical trial data were incorporated.ResultsHydroxychloroquine and azathioprine remain the cornerstones of pregnancy-compatible LN management. Tacrolimus is an acceptable calcineurin inhibitor with appropriate therapeutic drug monitoring. Low-dose aspirin is recommended universally to reduce preeclampsia risk. Mycophenolate mofetil is teratogenic and absolutely contraindicated in the first trimester. Voclosporin and obinutuzumab lack any pregnancy safety data and should be avoided. Belimumab data from the pregnancy registry have not raised major signals; selective use may be considered in refractory cases. Rituximab may be used cautiously for life-threatening disease, avoiding the third trimester due to neonatal B-cell depletion. Anifrolumab has no pregnancy data and should be reserved for situations where no compatible alternative exists.ConclusionThe growing number of effective LN therapies creates both opportunities and new dilemmas in pregnancy management. A structured, phase-based approach to drug selection - anchored in preconception counselling, timely medication switches, and multidisciplinary surveillance - is essential to optimise maternal and fetal outcomes. Dedicated pregnancy registries for novel biologics are urgently needed.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"1217-1226"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inaugural complete heart block in anti-SSA negative systemic lupus erythematosus: the diagnostic role of anti-PM-Scl 100 antibodies.","authors":"Nadia Dammene Debbih, Leila Laouar, Nassima Dekdouk, Houda Belguendouz, Riad Benkouar, Mohamed Seddik Aït Messaoudène","doi":"10.1177/09612033261474084","DOIUrl":"10.1177/09612033261474084","url":null,"abstract":"<p><p>IntroductionComplete heart block (CHB) is an exceptionally rare manifestation of adult systemic lupus erythematosus (SLE), typically occurring in less than 1% of patients. While classically associated with anti-SSA/Ro antibodies, we report a rare case of inaugural CHB in a young woman with anti-SSA-negative SLE, highlighting the diagnostic importance of anti-PM-Scl 100 antibodies and microvascular assessment.Case DescriptionA 21-year-old woman with a strong family history of SLE presented with symptomatic CHB (40 bpm). Cardiac MRI and standard workup ruled out myocarditis, infiltrative diseases, and common reversible causes. The patient showed subtle \"sentinel\" signs, including alopecia and inflammatory arthralgia. Immunological profiling revealed positive ANA (1/160) and elevated anti-dsDNA, but strict negativity for anti-SSA/Ro and anti-SSB/La. However, anti-PM-Scl 100 antibodies were strongly positive. Nailfold capillaroscopy demonstrated organic microangiopathy, supporting a microvascular-driven pathogenic process. A dual-chamber pacemaker was implanted due to irreversible conduction failure.DiscussionThis case challenges the diagnostic reliance on classic Ro/La antibodies for autoimmune CHB. The presence of anti-PM-Scl 100 and microvascular alterations on capillaroscopy suggests that nodal damage may result from an insidious fibrotic or microvascular process rather than acute inflammatory myocarditis. This \"microvascular hit\" can induce structural degradation even when systemic disease activity is quiescent.ConclusionCHB can be the inaugural sign of SLE even in the absence of anti-SSA antibodies. We recommend integrating extended antibody profiling and nailfold capillaroscopy into the diagnostic workup of unexplained heart block in young adults to bridge the current \"diagnostic gap\" in atypical autoimmune presentations.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"1324-1328"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achievement of real-world adapted DORIS remission targets among patients with systemic lupus erythematosus initiating belimumab in the USA: A retrospective, observational, cohort study.","authors":"Aarat M Patel, Renee L Gennarelli, Temitope Bello, Ali Bonakdar, Karen Worley","doi":"10.1177/09612033261473961","DOIUrl":"10.1177/09612033261473961","url":null,"abstract":"<p><p>IntroductionRemission is a key treatment goal associated with improved patient outcomes in systemic lupus erythematosus (SLE), often measured by Definition of Remission In SLE (DORIS) criteria. In a <i>post hoc</i> analysis of clinical trial data, belimumab, a B-cell modulator targeting the central immunopathogenic pathway in SLE, plus standard therapy, improved DORIS remission rates versus placebo plus standard therapy; however, US real-world remission rates remain limited. Measuring DORIS criteria in real-world clinical practice is challenging because required variables, particularly the SLE Disease Activity Index (SLEDAI) component, are often unavailable or incompletely recorded. Therefore, we evaluated an adapted DORIS definition for real-world datasets and examined predictors of remission among US patients initiating belimumab.MethodsThis retrospective observational cohort study analysed data for patients with SLE initiating belimumab from the OM1 PremiOM™ SLE dataset, comprising electronic health records/healthcare claims data (2013-2024) for patients with SLE. The primary outcome was probability of achieving adapted DORIS remission at 28, 48, and 52 weeks post-treatment initiation, defined as clinician-recorded SLEDAI (crSLEDAI) or estimated SLEDAI (eSLEDAI) = 0, Physician Global Assessment (PGA) <2 on a 0-10 numerical rating scale, and prednisone-equivalent dose ≤5 mg/day. Kaplan-Meier estimates provided remission probabilities and logistic regression identified predictors of remission.ResultsMost patients (<i>N</i> = 398) were White, female, from the Southern region of the USA, and had commercial insurance. The probability of achieving adapted DORIS remission reached 28.3% (95% confidence interval: 19.8-35.9) by 52 weeks post-belimumab initiation. Older patients (≥50 years), non-White individuals, and patients with cr/eSLEDAI ≤5 demonstrated slightly higher remission probabilities than their counterparts; however, estimates differed by censoring approach, and confidence bounds overlapped. Adjusted multivariable analysis confirmed increasing age, non-White race, and cr/eSLEDAI ≤5 as significant predictors of remission.ConclusionThis study demonstrates the application of an adapted DORIS definition to large real-world observational datasets. The probability of adapted DORIS remission in US patients initiating belimumab was similar to rates reported in observational studies outside the USA, supporting the real-world effectiveness of belimumab. The increased likelihood of remission in patients with cr/eSLEDAI ≤5 supports the benefits of initiating belimumab treatment early in the disease course.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"1246-1256"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two cases of therapy-refractory chilblain lupus erythematosus successfully treated with deucravacitinib.","authors":"Robin Springer, Andrew Moufarrej, Bernhard Homey, Stephan Meller","doi":"10.1177/09612033261473986","DOIUrl":"10.1177/09612033261473986","url":null,"abstract":"<p><p>Chilblain lupus erythematosus is a rare skin manifestation of lupus erythematosus (LE), which has proven particularly difficult to treat and therefore often presents a great challenge for patients and physicians. We treated two patients with cases of long-lasting, refractory chilblain LE with the selective, allosteric TYK2-inhibitor deucravacitinib. Both patients showed rapid improvement of their respective skin lesions and symptoms. The treatment was generally well tolerated with no severe adverse events. One of the patients experienced an intermittent occurrence of acne lesions. We therefore suggest deucravacitinib as a promising and safe off-label treatment option for chilblain LE.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"1320-1323"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent advances in the management of pediatric neuropsychiatric lupus from conventional therapies to novel immunomodulators.","authors":"Yunyan Li, Shiling Zhong, Yuanling Chen, Ling Wu","doi":"10.1177/09612033261466741","DOIUrl":"10.1177/09612033261466741","url":null,"abstract":"<p><p>Neuropsychiatric systemic lupus erythematosus (NPSLE) is a severe and potentially life-threatening complication of systemic lupus erythematosus (SLE), particularly in pediatric populations, in whom central nervous system involvement is often more aggressive and associated with long-term neurocognitive sequelae. Diagnosis remains challenging due to heterogeneous clinical manifestations and the lack of specific biomarkers. Traditionally, management has relied on high-dose corticosteroids, intravenous cyclophosphamide, and plasma exchange for refractory cases. However, emerging evidence supports the potential role of targeted immunomodulatory therapies, including rituximab, belimumab, anifrolumab, and emerging B-cell-directed strategies, although pediatric NPSLE-specific evidence remains limited. Novel agents such as type I interferon inhibitors, JAK inhibitors, and BTK inhibitors are currently under investigation in both adult and pediatric populations, offering the promise of more precise and less toxic interventions. This review summarizes current diagnostic approaches, first- and second-line therapies, and recent advances in biologic and small-molecule therapies for pediatric NPSLE. We also highlight ongoing clinical trials and future directions, emphasizing the importance of early recognition, multidisciplinary management, and the development of pediatric-specific guidelines. As understanding of the immunopathogenesis of NPSLE evolves, personalized therapeutic strategies may substantially improve long-term neurological and developmental outcomes in affected children.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"1120-1133"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydroxychloroquine-induced retinopathy in Puerto Ricans with systemic lupus erythematosus: Associated factors and early-onset risk.","authors":"Valeria Valentín-Rosa, Kamille Ruiz, Grecia Torres-Borges, Luis M Vilá","doi":"10.1177/09612033261469027","DOIUrl":"10.1177/09612033261469027","url":null,"abstract":"<p><p>ObjectiveTo determine factors associated with hydroxychloroquine (HCQ)-induced retinopathy in Puerto Ricans with systemic lupus erythematosus (SLE) and to evaluate determinants of early HCQ-induced retinopathy.MethodsWe conducted a retrospective study of adult Puerto Ricans with SLE. Patients with ophthalmologist-confirmed HCQ-induced retinopathy were compared with those without retinopathy. A subgroup analysis comparing patients with early-onset (≤5 years) versus late-onset (>5 years) retinopathy was also performed. Demographic factors, clinical manifestations, and pharmacologic treatments were analyzed using bivariate methods and logistic regression models adjusted for SLE duration.ResultsA total of 279 patients were included; 41 had HCQ-induced retinopathy, while 238 did not. Among patients with HCQ-induced retinopathy, the mean age (SD) was 45.2 (13.2) years, and 90.2% were women. The mean (SD) SLE duration and HCQ treatment duration were 10.3 (7.7) years and 9.1 (5.8) years, respectively. Patients with HCQ-induced retinopathy were more likely to have higher daily and weight-adjusted HCQ doses and greater damage accrual, but were less likely to have proteinuria, lymphopenia, anti-dsDNA positivity, low complement levels or exposure to mycophenolate mofetil. Among patients with HCQ-induced retinopathy, 13 (31.7%) discontinued HCQ within 5 years of treatment initiation. In multivariable analysis, early-onset toxicity was associated with corticosteroid exposure.ConclusionsIn this cohort of Puerto Rican Hispanics with SLE, HCQ-induced retinopathy occurred in 14.7% of patients, and nearly 32% of those affected developed early-onset retinopathy. Retinopathy was primarily associated with higher daily and weight-adjusted HCQ doses, while early-onset retinopathy was associated with corticosteroid exposure. These findings provide population-specific data that may help optimize HCQ dosing and underscore the importance of regular ophthalmologic screening, even during the early years of therapy.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"1203-1214"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatal SLE-associated CAPS despite eculizumab therapy.","authors":"Mehmet İhsan Başkaya, Gülnur Çelik Yılmaz, Mehmet Akif Baltacı, Emine Sarıyıldız, Melih Pamukcu","doi":"10.1177/09612033261477279","DOIUrl":"10.1177/09612033261477279","url":null,"abstract":"","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"1329-1330"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistence of antimalarial therapy and its effect on mortality in systemic lupus erythematosus: A population-based longitudinal multistate study.","authors":"Kai Zhao, Bocheng Jing, Bingfan Liu, Aosen Cheer, Antonio Aviña-Zubieta, Hui Xie","doi":"10.1177/09612033261474972","DOIUrl":"10.1177/09612033261474972","url":null,"abstract":"<p><p>ObjectiveExamine patients' Antimalarials (AM) use history and identify determinants of transitions among AM persistence, discontinuation, and death in a population-based incident cohort of Systemic Lupus Erythematosus (SLE) patients receiving AM.MethodsWe use population-based health administrative data to follow all British Columbia residents with incident SLE who initiate AM. Persistence is defined as the period from the pharmacy fill date until the supplied quantity is exhausted, with a gap of at least three consecutive months without an AM prescription, marking entry into the discontinuation state; episodes are tracked as transitions between these states and death. Transition-specific hazard ratios (HRs) are estimated using a reversible frailty multistate Cox model, adjusting for baseline demographics, comorbidities, healthcare use, and medications.ResultsThe cohort comprises 7,399 incident SLE patients initiating AMs. On average, patients spent half of their follow-up time in a state of persistence and the other half in discontinuation. The transitions show that while 99.2% of persistence episodes end in a lapse to discontinuation, only 64.5% of discontinuation episodes result in a return to persistence. Crucially, the risk of an episode ending in death is over five times higher during periods of discontinuation compared to persistence. Lapsing from persistence is less likely in rural residents (HR 0.94), users of cardiovascular drugs (0.87), and patients in higher-income areas (0.93), but more likely in those with alcohol-use disorder (1.47). Returning to persistence is inhibited by older age (0.995), depression (0.92), and higher comorbidity (0.97), yet encouraged by NSAID use (1.08). Among persistent patients, death is associated with older age (1.06 per year) and rural residence (1.67). Death during periods of discontinuation increases in men (HR 1.55), with older age (1.09 per year), greater outpatient use (1.014), the use of glucocorticoids (1.24), and cardiovascular drugs (1.30), and decreases with higher income (0.63 for quintile 4).ConclusionAM discontinuation is associated with higher mortality. Lower income, alcohol misuse, depression, multimorbidity, and complex drug regimens undermine AM persistence and heighten mortality. Financial support, counselling to reduce alcohol use, integrated mental-health care, and careful medication review may sustain persistence and improve survival in SLE.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"1282-1291"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum C-reactive protein levels can predict organ damage in patients with SLE with the lupus low disease activity state.","authors":"Tomoya Nakajima, Akira Onishi, Mirei Shirakashi, Ryosuke Hiwa, Hideaki Tsuji, Shuji Akizuki, Ran Nakashima, Hajime Yoshifuji, Masao Tanaka, Ayuko Takatani, Takahisa Onishi, Takashi Kida, Yoshia Miyawaki, Masataka Umeda, Hiroshi Kajiyama, Ryusuke Yoshimi, Yusuke Matsuo, Dai Kishida, Shuzo Sato, Shigeru Ohno, Michio Fujiwara, Nobuyuki Yajima, Ken-Ei Sada, Akio Morinobu","doi":"10.1177/09612033261473966","DOIUrl":"10.1177/09612033261473966","url":null,"abstract":"<p><p>ObjectivesThe importance of low detectable C-reactive protein (CRP) levels in patients with systemic lupus erythematosus (SLE) remains unclear. This study aimed to examine the association between CRP levels and damage accrual in SLE patients with low disease activity.MethodsPatients with SLE who met the criteria for lupus low disease activity state (LLDAS) at registration were divided into two groups: serum CRP levels consistently >1.0 mg/L (high CRP group) or ≤1.0 mg/L (low CRP group) at both registration and the first year. Damage accrual was assessed by evaluating the increase in the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI).ResultsAmong the 276 patients, 81 were in the high CRP group and 195 were in the low CRP group. Patients in the high CRP group were older, included a lower proportion of women and individuals using hydroxychloroquine, and had higher body mass index and SDI values at baseline. CRP categories were not associated with SDI progression (HR: 1.40, 95% CI: 0.85-2.31), whereas older patients were more likely to experience damage accrual (HR: 1.03, 95% CI: 1.01-1.05, p = 0.002). In the subgroup analysis limited to younger patients, the high CRP group showed more SDI progression (HR: 2.91, 95% CI: 1.21-7.03, p = 0.017).ConclusionCRP levels were associated with SDI progression in younger patients with LLDAS. Even in patients with inactive SLE, positive CRP levels may indicate the need to modify the treatment for SLE and reassess atherosclerotic risk factors.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"1238-1245"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}