RT Journal Article
SR Electronic
T1 Unique clinical characteristics, autoantibodies and medication use in Native American patients with systemic lupus erythematosus
JF Lupus Science & Medicine
FD Lupus Foundation of America
SP e000247
DO 10.1136/lupus-2017-000247
VO 5
IS 1
A1 Joseph M Kheir
A1 Carla J Guthridge
A1 Jonathon R Johnston
A1 Lucas J Adams
A1 Astrid Rasmussen
A1 Timothy F Gross
A1 Melissa E Munroe
A1 Rebecka L Bourn
A1 Kathy L Sivils
A1 Joel M Guthridge
A1 Michael H Weisman
A1 Daniel J Wallace
A1 Juan-Manuel Anaya
A1 Adriana Rojas Villarraga
A1 James N Jarvis
A1 John B Harley
A1 Judith A James
YR 2018
UL http://lupus.bmj.com/content/5/1/e000247.abstract
AB Objective Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with varied morbidity and mortality. We assessed clinical presentations, autoantibody specificities and therapeutic interventions in Native American (NA) patients with SLE.Methods Patients with SLE meeting 1997 American College of Rheumatology classification criteria (n=3148) were enrolled between 1992 and 2010 in the multiethnic, cross-sectional Lupus Family Registry and Repository. Clinical, demographic and therapeutic information were extracted from medical records using a standardised form and formalised training. Autoantibodies were assessed by indirect immunofluorescence (antinuclear antibodies (ANA) and antidouble-stranded DNA), precipitin (ENA) and ELISA (IgG and IgM anticardiolipins).Results NA patients met SLE classification at a younger age (29.89±12.3 years) than European Americans (EA; 32.02±12.87, P=0.0157) and a similar age to African-Americans (AAs) and Hispanics (HIS). More NA patients had concurrent rheumatic diseases or symptoms, such as Raynaud’s phenomenon, interstitial lung disease, Sjӧgren’s syndrome and systemic sclerosis. Compared with EAs, NAs were more likely to have high-titre ANA (≥1:3240; P<0.0001) and had more SLE-associated autoantibodies. Autoantibodies with unknown specificities were more common in NAs (41%) compared with other racial/ethnic groups in this collection (AA: 24%, P=0.0006; EA: 17%, P<0.0001; HIS: 23%, P=0.0050). Fewer NA patients used hydroxychloroquine (68%) compared with others (AA: 74%, P=0.0308; EA: 79%, P=0.0001, HIS: 77%, P=0.0173); this was influenced by lower hydroxychloroquine use in NA patients from Latin America (32%). NA patients had higher rates of methotrexate use (28%) compared with AA (18%, P=0.0006) and HIS patients (14%, P=0.0003), higher azathioprine use (38%) compared with EA patients (30%, P=0.0105) and higher mycophenolate mofetil use (26%) compared with EA (17%, P=0.0012) and HIS patients (11%, P<0.0001).Conclusions NA patients are diagnosed with SLE earlier in life and present worse concurrent rheumatic disease symptoms than EA patients. NA patients also are more likely to have expanded autoantibody profiles and precipitins of unknown specificities.