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monocyte chemotactic protein-1 (MCP-1), vascular cell adhesion molecule (VCAM)

intercellular adhesion molecule (ICAM/CD54) and overall complement [51]. Associations
between changes in disease activity and changes in biomarker levels were assessed [90]. In
terms of global disease activity, anti-C1q had the highest association with the PGA (p = 0.09)
and was strongly associated with modified SLEDAI (p = 0.009). In terms of renal activity,
anti-C1q had the highest association with proteinuria (p = 0.079), and was strongly associated
with the renal activity score (p = 0.006) [51]. The authors concluded that anti-C1q
demonstrated the best performance of the potential biomarkers, being significantly associated
with the modified SLEDAI and with the renal activity score. This study indicated the
potential superior utility of anti-C1q over anti-dsDNA and other measures to track lupus renal
activity [51].

Lupus and the Skin, Hair and Mucosae

In Table 3, we outline multiple mucocutaneous manifestations of lupus erythematosus.
The classic, presenting skin finding in lupus is the malar butterfly rash. The malar rash is a
red rash (and occasionally a mild blush) that occurs across the bridge of the nose and on the
cheeks, resulting in a distinctive butterfly shape appearance. Butterfly rashes tend to come
and go, depending on how active the underlying lupus is; it does not leave scars as it heals,
but may leave pigmentary alterations [90-101]. Discoid lupus is a type of lupus that tends to
be confined to the skin, with other organs in the body not involved. Discoid lupus occurs in
patches. The patches tend to be well defined, thickened and scaly; they are slightly red in
color and may itch. As the patches heal, they tend to leave scars; in dark skin the skin pigment
may be lost, forming residual white areas. If discoid lupus occurs on the scalp, the hair will
often be lost, leaving permanent bald areas [90-101]. Subacute cutaneous lupus
erythematosus (SCLE) presents as a distinctive rash, that usually occurs in sun exposed areas
of the body. It begins as scaly patches which increase in size to form circular areas, which
then gradually heal without leaving scars [90-101]. SCLE clinically often presents in a range
between the systemic form and the discoid form; specifically, patients with subacute
cutaneous lupus often have some of the blood abnormalities found in systemic lupus and
frequently experience joint pains, but they do not classically develop the serious
complications that can occur in SLE [90-101]. A panniculitis represents inflammation of the
fat below the skin, resulting in tender red subcutaneous lumps; these heal slowly over time
and can cause residual dimpling of the skin. Lupus patients may manifest a panniculitis,
presenting as either lupus panniculitis or lupus profundus. Lupus may affect the blood vessels
in the skin, causing a vasculitis [90-101]. Vasculitis may cause painful red macules, often
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present on the legs and arms. A lupus vasculitis may also occur in other areas of the body; for
example, it may occur in the kidney, and if present, may represent a serious complication
necessitating prompt treatment. In addition, blood flow through skin blood vessels may
become sluggish in lupus patients with the antiphospholipid antibody syndrome (APS/Hughes
Syndrome) [90-101]. In these patients, the skin may take on a mottled or net-like appearance
known as livedo reticularis. Livedo reticularis often presents on the legs and arms. Patient
scalp hair may be affected in lupus. The hair often thin, and can become patchy when lupus is
active. It will often regrow if the disease is brought under control. However, as previously

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