BRIEF REPORT Application of a nomogram for exercise capacity in women with systemic lupus erythematosus E. M. Hazel & S. Bernatsky & D. Da Costa & K. Dasgupta & A. E. Clarke & L. Joseph & Y. St Pierre & C. A. Pineau Received: 16 January 2009 / Accepted: 27 January 2009 / Published online: 17 February 2009 # Clinical Rheumatology 2009 Abstract The aim of this study is to examine the exercise capacity in women with systemic lupus erythematosus (SLE). Women with SLE underwent exercise testing; their performance was compared to nomogram predictions. We assessed the potential effects of disease activity and cumulative damage on exercise capacity. We evaluated 52 female SLE patients aged >35 years. The mean workload achieved was somewhat higher than the nomogram pre- dictions. However, over one fifth of the women performed at a very poor level, which in the general population is associated with a twofold increased risk of cardiovascular disease. Compared to other subjects, participants who did poorly tended toward higher disease activity, higher body mass index, and greater smoking prevalence, although the results were not definitive. Exercise testing may be used to identify a subpopulation of lupus patients with a low level of fitness. Extrapolating from general population data, these individuals are likely at particular risk for cardiovascular disease and may, therefore, benefit the most from aggres- sive cardiovascular risk factor reduction. Keywords Cardiac risk . Exercise capacity . Nomogram . SLE . Systemic lupus erythematosus Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease predominantly affecting women. SLE patients have up to a 50-fold increased risk of coronary artery disease (CAD) [1]. The contribution of CAD to mortality in SLE is especially significant in patients with longer disease duration and seems to be independent of lupus disease activity [2, 3]. The mortality attributable to CAD is as high as 36.4% in SLE patients [4, 5]. However, the uniform application of aggressive risk reduction strategies may expose some patients to untoward side effects [6]. Consequently, there has been much debate about how to prioritize those patients who would most benefit for treatment [7]. In the general population, the Framingham study identified age, abnormal cholesterol levels, elevated blood pressure, diabetes, and smoking as risk factors for the development of CAD [3]. The excess of cardiac events in SLE is not explained by the Framingham risk factors alone [8]. However, lupus-related factors including markers of disease activity and damage have not been shown to be accurate predictors of CAD in these patients [5]. Exercise capacity has been demonstrated to be an independent predictor of cardiac events and mortality in the general population [9]. Until recently, the majority of work on exercise capacity and CAD has been conducted in men. This has complicated the extrapolation of the data to SLE, a disease affecting predominantly women. Two small studies of exercise capacity in SLE patients concluded that Clin Rheumatol (2009) 28:719–722 DOI 10.1007/s10067-009-1113-3 E. M. Hazel : S. Bernatsky : C. A. Pineau Division of Rheumatology, McGill University Health Centre (MUHC), Montreal, QC, Canada S. Bernatsky (*) : D. Da Costa : K. Dasgupta : A. E. Clarke : L. Joseph : Y. St Pierre Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre (MUHC), Royal Victoria Hospital, 687 Pine Avenue West, V-Pavilion, Room V2.09, Montreal, QC, Canada, H3A 1A1 e-mail: sasha.bernatsky@mail.mcgill.ca A. E. Clarke Division of Allergy and Clinical Immunology, McGill University Health Centre (MUHC), Montreal, QC, Canada