Patients were enrolled within 15 months of recognition of four or more 1997 ACR classification criteria for SLE.19 (link) We included patients who either had two study visits or had died after their first study visit, that is, patients who had two data points to model statistically. There were no specific exclusion criteria other than failing to meet four ACR criteria and it being >15 months since diagnosis. We noted demographic features including age, gender, race/ethnicity, geographical region and years in post-secondary education. We also noted the number of ACR criteria fulfilled by the baseline visit. At each visit we also assessed the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K)20 (link) and the SDI.21 (link) At each visit we recorded whether the patient was taking corticosteroids (yes or no). In addition to steroid use, we also recorded whether patients were taking AMs, immunosuppressives (ISs), or both AMs and ISs. Co-morbidities (recorded at each visit) included in our analysis were diabetes mellitus (physician confirmed diagnosis) and hypertension (systolic blood pressure >140 mm Hg and/or diastolic blood pressure >90 mm Hg and/or taking antihypertensive medications). Baseline serological markers included antibodies to double-stranded DNA and C3 and C4 complement (in local clinical laboratories at each centre). Antibodies to cardiolipin, β-2-glycoprotein I and the lupus anti-coagulant were measured at a central laboratory at the Oklahoma Medical Research Foundation as previously described.22 (link) HRQOL was assessed using the Medical Outcomes Survey Short-Form 36 (SF-36). All patients provided written informed consent.