British Journal of Rheumatology 1992;31:773-774 CONFERENCE REPORT

LUPUS COMES OF AGE BY G. R. V. HUGHES AND M. KHAMASHTA The Rayne Institute, St Thomas' Hospital, London SE1 7EH

not impaired), on valve function, confirming the tendency to mitral valve prolapse on echo, and on the associations between anti-Ro and congenital heart block—an interesting study in this session showed that human IgG with Ro perfused into adult rabbit heart preparations was capable of inducing conduction abnormalities. On the clinical side, increasing emphasis is now being placed on neurological aspects of SLE, and the lessons central nervous system (CNS) lupus is providing in studies of neurological processes such as demyelination and cerebrovascular disease. CNS lupus studies included MRI (variable enthusiasm) blood flow (99m—Tc HMPAO—Spect analysis), gadolinium-enhanced MRI, and clinical (including cognitive function) assessment. The MRL-lpr mouse was shown to provide useful animal model data in CNS studies. Treatment discussions centred on the more widespread use of 'pulse' cyclophosphamide regimes in place of high dose steroids, experimental immunomodulation and plasma exchange. Perhaps the best attended session in this section was the update on antimalarials, which were shown to have wider clinical benefit than had perhaps previously been recognized, as well as having some interesting immunosuppressive and immunomodulatory effects. Pregnancy and pregnancy loss are major topics in any lupus clinic and the management of repeated abortion associated with antiphospholipid antibodies was covered in detail, anticoagulation regimes having largely replaced predominantly steroid-based regimes. Although it is only 10 years since the description of the antiphospholipid antibody syndrome, it was this aspect of lupus (or lupus-like disease) which attracted by far the most attention—indeed the single largest group of abstracts in the conference addressed themselves to mechanisms of antiphospholipid antibody binding. The recently described co-factor Beta 2 glycoprotein I was shown to be crucial in the hypercoagulable state associated with antiphospholipid antibodies, possibly enhancing antibody binding in patients with the antiphospholipid syndrome and not in the infection-related antibody patients. (Such is the interest in antiphospholipid antibodies that the 5th International Conference on this subject is already planned in San Antonio later this year.) Overviews were presented by Dr M. Khamashta, Dr D. Alarcon-Segovia, Dr R. Asherson and Dr S. Krilis, who reported that anticardiolipin (aCL) autoantibodies purified from patients with a range of infections

Accepted 29 July 1992. Correspondence to G. R. V. Hughes, Lupus Arthritis Research Unit, Rayne Institute, St Thomas' Hospital, London SE1 7EH. 0263-7103/92/011773 + 02 $08.00/0

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IT is almost exactly a hundred years since William Osier described in detail the clinical features of systemic lupus (including the neurological manifestations) and ascribed the symptoms to generalized vascular changes. In the Queen Elizabeth II Conference Centre in London on the 13-15 April this year, 1000 physicians, scientists, research fellows and 'SLE-immunologists' from 46 countries gathered for the Third International Conference on Systemic Lupus Erythematosus (SLE). The rapid international growth of interest in lupus during the past two decades is reflected in the history of this conference. The first such meeting, organized by Dr Marvin Fritzler in Calgary in 1986 attracted some 200 delegates and was followed by a second meeting in Singapore in 1989 under the leadership of Professor Feng, when the number attending climbed to 450. Within three years the attendance has doubled and the London meeting supported four parallel scientific sessions. There were genuine advances in epidemiology. Abstracts were presented from countries worldwide underlining the increase of awareness of the disease in all corners of the earth. Whereas 20 years ago, series of over 100 patients were rare, today they are the norm. Lupus is no longer a rare disease. With a prevalence rate of 1:1000 women, it is more common than, for example, multiple sclerosis, and in many countries, notably in the Far East, its prevalence has overtaken that of rheumatoid arthritis. A number of collaborative international data collecting exercises are now under way. One of these was the 'Eurolupus' study, involving 1000 patients in seven European centres in Norway, Turkey, Italy, Spain, the Netherlands and London. Large studies were presented from India, Greece, Caribbean countries, Chile, Argentina, as well as the USA and Australasia. There were separate sessions on pediatric lupus (where prognosis data was shown to be similar to that in adults) in skin lupus, lungs, nephritis (including an update on the NIH extended study, where pulse cyclophosphamide is confirmed as being superior to pulse methyl prednisolone: perhaps surprisingly, sustained treatment appeared to be more effective than short intensive pulse cyclophosphamide in achieving lasting remission). Cardiac studies in SLE included coronary flow evaluation (coronary flow reserve in this study was

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BRITISH JOURNAL OF RHEUMATOLOGY VOL. XXXI NO. 11 immunization with monoclonal anti-cardiolipin antibodies, studies of SCID mice in autoimmunity, and modification of SLE in NZB/NZW mice by peptide immunization. Gharavi etal. in an interesting series of experiments showed that immunization with purified foreign apolipoprotein H (B2-GPI) could, in certain species, result in the production of high levels of antiphospholipid antibodies in the absence of exogenous phospholipid—a possible example of a model for the breaking of tolerance and resultant autoantibody production. One of the most pleasing aspects of the meeting was the co-existence of a parallel international patients' conference, with representatives of lupus groups exchanging information with participants at the medical meeting.

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were able to bind directly to cardiolipin in the absence of B2-GPI, while those from auto-immune patients have specificity for B2-GPI and are associated with thrombosis. Dr M. Lockshin reviewed the data (also covered in two other sessions in the Conference), on antiphospholipid antibody and pregnancy loss. Plenary sessions were devoted to complement, cytokines and SLE, autoantibodies, thymic hormones, idiotypes (the idiotype workshop will be published in a future edition of Lupus), molecular biology of the antigens, viruses, stress proteins, to immunogenetics (the C4 null allele association is widely confirmed) and the effect of sex hormones on disease modulation of the disease and its underlying immunological aberrations. The animal model session drew a packed auditorium and considerable discussion, with models including

Lupus comes of age.

British Journal of Rheumatology 1992;31:773-774 CONFERENCE REPORT LUPUS COMES OF AGE BY G. R. V. HUGHES AND M. KHAMASHTA The Rayne Institute, St Thom...
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