These findings contributed to the development of the first lupus prevention trial, the Study of Anti-Malarials in Incomplete Lupus Erythematosus (SMILE). This multi-center, randomized, placebo-controlled, double-blind, parallel group, 36-month clinical trial will evaluate the efficacy and safety of hydroxychloroquine intervention to prevent autoantibody accrual and future onset of clinically apparent SLE. SMILE will enroll 120 patients who are ANA positive and have at least one clinical lupus criterion, testing whether a high-risk soluble mediator score, genetic risk score or some combination best predicts who will transition to lupus. SMILE is now recruiting patients.
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“We are testing whether we can slow progression to lupus, or if we can decrease the number of autoantibodies. We’re also testing some of these high-risk soluble mediator scores identified in other cohorts to see if we can identify who will or won’t transition, and we’re looking at the total genetic load using data from recent trials,” said Dr. James.
Clinical rheumatologists who receive questions about lupus risk from family members should stress that most relatives will not transition to disease. “If you have family members who are really stressed about whether they will develop lupus, or if they have a positive ANA or some clinical feature, we can share lifestyle choices that may help them, based on data that these may be associated with lupus transition and are good ideas for your health anyway,” such as quitting smoking, getting adequate sleep, ensuring adequate vitamin D levels and maintaining ideal body weight, she concluded.
Susan Bernstein is a freelance journalist based in Atlanta.
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