Ammar Y, Mohamed A, Khalil G, et al. - Among systemic lupus erythematosus (SLE) patients, there exists a key role of FGF23 (fibroblast growth factor-23)-phosphate axis in accelerated atherosclerotic cardiovascular disease (ACVD), and including serum phosphorus and intact FGF23 (iFGF23) in ACVD risk profile evaluation of these patients is recommended.

• This study involved three study groups of predominantly middle-aged females: SLE [without lupus nephritis (LN)], LN, or controls.

• Carotid ultrasonography was conducted.

• Among study groups, differences in common carotid artery intima-media thickness (CC-IMT), internal carotid resistive index and serum iFGF23 (LN>SLE>controls) were evident.

• A significant positive correlation of serum iFGF23 with serum phosphorus, CC-IMT and plaque score was found in both SLE and LN cases.

• Cumulative steroid dose in SLE and serum iFGF23 in LN patients was revealed as the strongest predictor of increased CC-IMT, in the multivariate analysis.

• Hyperphosphatemia in SLE and proteinuria in LN patients were found as the most significant independent predictors of elevated serum iFGF23.