title: Elevated B lymphocyte stimulator levels are associated with increased damage in an Irish systemic lupus erythematosus cohort.
abstract: OBJECTIVE
  The overall aim of this study is to identify clinical and serological features that are associated with B lymphocyte stimulator (BLyS) elevation in a homogeneous Caucasian SLE population and thereby identify patients who are most likely to benefit from BLyS blockade.
  
  
  METHODS
  Patients with SLE (as per ACR criteria) were recruited. Clinical history, disease activity measures and laboratory measures of disease were recorded. BLyS levels were determined by ELISA.
  
  
  RESULTS
  BLyS elevation was defined as being higher than the 95th percentile of BLyS levels measured in controls. Patients were divided into two groups: those with elevated BLyS levels (group 1, n = 23) and those with normal BLyS levels (group 2, n = 22). Elevated BLyS levels were significantly associated with patients of younger age and shorter disease duration. In keeping with previous reports, patients with elevated BLyS levels had more active disease (SLEDAI 5.1 vs 0.86, P < 0.001); however, our analysis also demonstrates that BLyS elevation was significantly associated with increased organ damage at 5-year follow-up [Systemic Lupus International Collaborating Clinics/ACR Damage Index (SLICC/ACR DI) 0.53 vs 0.13, P = 0.012]. Furthermore, the presence of Sm autoantibody significantly predicted elevated BLyS levels in a Caucasian population. BLyS levels were significantly higher in those with musculoskeletal involvement, malar rash, renal disease and evidence of immunological activity.
  
  
  CONCLUSIONS
  BLyS blockade may be most beneficial if introduced early in the course of disease in young Caucasian patients presenting with renal, musculoskeletal and skin disease in an effort to reduce long-term damage.
authors.affiliation: Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland. eoghanmmccarthy@rcsi.ie
authors.forename: Eoghan M
authors.initials: EM
authors.lastname: McCarthy
authors.forename: Ruth Z
authors.initials: RZ
authors.lastname: Lee
authors.forename: Joan
authors.initials: J
authors.lastname: Ní Gabhann
authors.forename: Siobhán
authors.initials: S
authors.lastname: Smith
authors.forename: Gaye
authors.initials: G
authors.lastname: Cunnane
authors.forename: Michele F
authors.initials: MF
authors.lastname: Doran
authors.forename: Donough
authors.initials: D
authors.lastname: Howard
authors.forename: Paul
authors.initials: P
authors.lastname: O'Connell
authors.forename: Grainne
authors.initials: G
authors.lastname: Kearns
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Jefferies
mesh_terms: D000328:Adult; D000367:Age Factors; D001323:Autoantibodies / Q000097:blood; D053264:B-Cell Activating Factor / Q000097:blood*; D016022:Case-Control Studies; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007494:Ireland; D008180:Lupus Erythematosus, Systemic / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012720:Severity of Illness Index
chemical_list: D001323:Autoantibodies; D053264:B-Cell Activating Factor
keywords: B lymphocyte stimulator; age; damage; disease activity; systemic lupus erythematosus