Background and aims Lupus and lupus nephritis progression and flares are difficult to predict. Recently, osteoprotegerin, endothelin-1, CXCR3⁺ CD4⁺ T cells and MCP-1 mRNA expression in urine sediments have been described as possible biomarkers of lupus and lupus nephritis. But their relationship with histological activity has not been sufficiently explored. It is desired that biomarkers of a disease should more rapidly reflect disease progression which would allow shorter clinical proof of concept trials and should be able to predict flares, measure current disease activity and severity, predict progression of disease and prognosis.

Methods It is likely that continued inflammatory events seen in lupus could be due to failure of the resolution of inflammation. Thus, the balance between inflammation and resolution is tilted more in favour of pro-inflammatory events and/or failure of production of pro-resolution molecules at the most appropriate time leading to non-resolution of inflammation. One such endogenous pro-resolution and anti-inflammatory molecule is lipoxin A₄, whose deficiency could lead to continuation of inflammation in lupus and lupus nephritis.

Results It was noted that low plasma and urinary lipoxin A₄ indicated disease activity and progression of disease, while a fall in its levels were noted prior to impending flares and increase in disease activity; and an increase in the levels of lipoxin A₄ suggested resolution of inflammation and amelioration of disease process.

Conclusions It is suggested that measurement of plasma and urinary lipoxin A₄ will be a good biomarker to predict flares, measure current disease activity and severity, predict progression of disease and prognosis.