{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:28:21Z","timestamp":1792787301673,"version":"4.5.0"},"reference-count":15,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,4,30]],"date-time":"2020-04-30T00:00:00Z","timestamp":1588204800000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Exagen"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Lupus Sci Med"],"accepted":{"date-parts":[[2020,4,17]]},"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the association between lupus severity and cell-bound complement activation products (CB-CAPs) or low complement proteins C3 and C4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All subjects (n=495) fulfilled the American College of Rheumatology (ACR) classification criteria for SLE. Abnormal CB-CAPs (erythrocyte-bound C4d or B-lymphocyte-bound C4d levels &gt;99th percentile of healthy) and complement proteins C3 and C4 were determined using flow cytometry and turbidimetry, respectively. Lupus severity was estimated using the Lupus Severity Index (LSI). Statistical analysis consisted of multivariable linear regression and groups comparisons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Abnormal CB-CAPs were more prevalent than low complement values irrespective of LSI levels (62% vs 38%, respectively, p&lt;0.0001). LSI was low (median 5.44, IQR: 4.77\u20136.93) in patients with no complement abnormality, intermediate in patients with abnormal CB-CAPs (median 6.09, IQR: 5.31\u20138.20) and high in the group presenting with both abnormal CB-CAPs and low C3 and\/or C4 (median 7.85, IQR: 5.51\u20138.37). Odds of immunosuppressant use was higher in subjects with LSI \u22655.95 compared with subjects with LSI &lt;5.95 (1.60 vs 0.53, p&lt;0.0001 for both). Multivariable regression analysis revealed that higher LSI scores associated with abnormal CB-CAPs\u2014but not low C3\/C4\u2014after adjusting for younger age, race and longer disease duration (p=0.0001), which were also independent predictors of disease severity (global R\n                      <jats:sup>2<\/jats:sup>\n                      =0.145).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Abnormalities in complement activation as measured by CB-CAPs are associated with increased LSI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/lupus-2019-000377","type":"journal-article","created":{"date-parts":[[2020,5,5]],"date-time":"2020-05-05T13:42:32Z","timestamp":1588686152000},"page":"e000377","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Cell-bound complement activation products associate with lupus severity in SLE"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9546-1664","authenticated-orcid":false,"given":"Cristina","family":"Arriens","sequence":"first","affiliation":[{"name":"Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA"},{"name":"University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8827-8637","authenticated-orcid":false,"given":"Roberta Vezza","family":"Alexander","sequence":"additional","affiliation":[{"name":"Exagen Inc, Vista, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonali","family":"Narain","sequence":"additional","affiliation":[{"name":"Rheumatology, Northwell Health, Great Neck, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Saxena","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Care, New York University, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher E","family":"Collins","sequence":"additional","affiliation":[{"name":"MedStar Washington Hospital Center, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J","family":"Wallace","sequence":"additional","affiliation":[{"name":"Attune Health, Beverly Hills, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Massarotti","sequence":"additional","affiliation":[{"name":"Rheumatology, Harvard University, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Conklin","sequence":"additional","affiliation":[{"name":"Exagen Inc, Vista, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth C","family":"Kalunian","sequence":"additional","affiliation":[{"name":"Rheumatology, University iof California San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3204-6068","authenticated-orcid":false,"given":"Chaim","family":"Putterman","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Albert Einstein College of Medicine, Bronx, New York, USA"},{"name":"Azrieli Faculty of Medicine, Bar Ilan University, Zefat, Israel"},{"name":"Research Institute, Galilee Medical Center, Nahariya, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalind","family":"Ramsey-Goldman","sequence":"additional","affiliation":[{"name":"Medicine\/Rheumatology, Northwestern University, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill P","family":"Buyon","sequence":"additional","affiliation":[{"name":"New York University School of Medicine, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca","family":"Askanase","sequence":"additional","affiliation":[{"name":"Rheumatology, Columbia University Medical Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard A","family":"Furie","sequence":"additional","affiliation":[{"name":"Rheumatology, Northwell Health, Great Neck, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith A","family":"James","sequence":"additional","affiliation":[{"name":"Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA"},{"name":"University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghalib A","family":"Bello","sequence":"additional","affiliation":[{"name":"Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Manzi","sequence":"additional","affiliation":[{"name":"Allegheny Health Network, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Ahearn","sequence":"additional","affiliation":[{"name":"Allegheny Health Network, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4439-1395","authenticated-orcid":false,"given":"Tyler","family":"O\"Malley","sequence":"additional","affiliation":[{"name":"Exagen Inc, Vista, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur","family":"Weinstein","sequence":"additional","affiliation":[{"name":"Exagen Inc, Vista, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3799-4438","authenticated-orcid":false,"given":"Thierry","family":"Dervieux","sequence":"additional","affiliation":[{"name":"Exagen Inc, Vista, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,5,5]]},"reference":[{"key":"2025091513180191000_7.1.e000377.1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780400928"},{"key":"2025091513180191000_7.1.e000377.2","doi-asserted-by":"publisher","DOI":"10.1002\/art.34473"},{"key":"2025091513180191000_7.1.e000377.3","doi-asserted-by":"publisher","DOI":"10.1002\/art.40930"},{"key":"2025091513180191000_7.1.e000377.4","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.immunol.22.012703.104549"},{"key":"2025091513180191000_7.1.e000377.5","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2017-000236"},{"key":"2025091513180191000_7.1.e000377.6","doi-asserted-by":"publisher","DOI":"10.1002\/art.34669"},{"key":"2025091513180191000_7.1.e000377.7","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2015-000127"},{"key":"2025091513180191000_7.1.e000377.8","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2014-000056"},{"key":"2025091513180191000_7.1.e000377.9","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2018-000263"},{"key":"2025091513180191000_7.1.e000377.10","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2015-000136"},{"key":"2025091513180191000_7.1.e000377.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jim.2017.04.001"},{"key":"2025091513180191000_7.1.e000377.12","first-page":"301","article-title":"The impact of race and ethnicity on disease severity in systemic lupus erythematosus","volume":"19","author":"Crosslin","year":"2009","journal-title":"Ethn Dis"},{"key":"2025091513180191000_7.1.e000377.13","doi-asserted-by":"publisher","DOI":"10.1002\/art.38239"},{"key":"2025091513180191000_7.1.e000377.14","doi-asserted-by":"publisher","DOI":"10.1002\/art.38238"},{"key":"2025091513180191000_7.1.e000377.15","doi-asserted-by":"publisher","DOI":"10.1177\/096120339300200210"}],"container-title":["Lupus Science &amp; Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/lupus-2019-000377","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T20:18:10Z","timestamp":1757967490000},"score":1,"resource":{"primary":{"URL":"https:\/\/lupus.bmj.com\/lookup\/doi\/10.1136\/lupus-2019-000377"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,5,5]]},"published-print":{"date-parts":[[2020,4]]}},"alternative-id":["10.1136\/lupus-2019-000377"],"URL":"https:\/\/doi.org\/10.1136\/lupus-2019-000377","relation":{},"ISSN":["2053-8790"],"issn-type":[{"value":"2053-8790","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4]]}}}