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Epidemiology and outcomes
Unique clinical characteristics, autoantibodies and medication use in Native American patients with systemic lupus erythematosus
  1. Joseph M Kheir1,
  2. Carla J Guthridge1,
  3. Jonathon R Johnston1,2,
  4. Lucas J Adams1,
  5. Astrid Rasmussen1,
  6. Timothy F Gross1,
  7. Melissa E Munroe1,
  8. Rebecka L Bourn1,
  9. Kathy L Sivils1,
  10. Joel M Guthridge1,
  11. Michael H Weisman3,
  12. Daniel J Wallace3,
  13. Juan-Manuel Anaya4,
  14. Adriana Rojas Villarraga5,
  15. James N Jarvis6,
  16. John B Harley7,8 and
  17. Judith A James1,9
  1. 1 Department of Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
  2. 2 Oklahoma State University Health Sciences Center, Tulsa, Oklahoma, USA
  3. 3 Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
  4. 4 Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
  5. 5 Artmedica IPS, Bogotá, Colombia
  6. 6 Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
  7. 7 Center for Autoimmune Genomics and Etiology (CAGE), Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
  8. 8 US Department of Veterans Affairs Medical Center, Cincinnati, Ohio, USA
  9. 9 Department of Medicine and Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  1. Correspondence to Dr Judith A James; judith-james{at}omrf.org

Abstract

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.

  • systemic lupus erythematosus (SLE)
  • antinuclear antibodies (ANA)
  • autoantibodies

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/lupus-2017-000247

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    Footnotes

    • Contributors JMK, CJG, JBH and JAJ designed the study. All authors participated in data acquisition, analysis and/or interpretation. All authors assisted with the development of the manuscript and approved the final version to be published. JAJ had final responsibility for the decision to submit for publication.

    • Funding Research reported in this publication was supported by grants from the National Institutes of Health, the Indian Health Service and the US Department of Veterans Affairs (U26IHS0088, U54GM104938, P30GM103510, P30AR053483, U19AI082714, U01AI101934, U01AII30830, R01AI024717, U01HG008666 and I01BX001834). Research reported herein was supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health.

    • Disclaimer The study sponsors had no role in the study design; in the collection, analysis and interpretation of the data; in the writing of the report; nor in the decision to submit the paper for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the Indian Health Service, or the United States Government.

    • Competing interests AR reports personal fees from ThermoFisher for talks regarding diagnosis and classification of Sjögren’s syndrome and the different autoantibody testing platforms.

    • Patient consent Not required.

    • Ethics approval Research was approved by the Institutional Review Boards of the Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All relevant data for this study are being published.