Reumatología Clínica

Reumatología Clínica

Volume 7, Issue 1, January–February 2011, Pages 3-6
Reumatología Clínica

Editorial
Multiethnic lupus cohorts: What have they taught us?Cohortes multiétnicas de Lupus: ¿qué nos han enseñado?

https://doi.org/10.1016/j.reuma.2010.11.001Get rights and content

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Disease activity

We measured disease activity in LUMINA using the Systemic Lupus Activity Measure-Revised or SLAM-Revised or SLAM-R; we chose this instrument over the SLEDAI, the SELENA SLEDAI and the BILAG for its relative simplicity and ease of administration, the fact that it did not require expensive immunological tests, and our familiarity with it. Factors associated with disease activity at disease onset included the absence of HLA-DRB1*0301, African American ethnicity, lack of health insurance, and the

Damage accrual

Damage in SLE, as defined by the SLICC (for Systemic Lupus International Collaborating Clinics) Damage Index or SDI has repeatedly been shown to be associated with disease activity, disease duration, age, and the use of glucocorticoids. These variables have been also associated with damage accrual in patients from the LUMINA cohort. In addition, we have also demonstrated that poverty (as defined by the US Federal government) and being of African descend or of Hispanic-Amerindian heritage are

Renal involvement

Lupus nephritis, perhaps the most typical and worrisome manifestation of lupus, occurs in about 20–65% of patients and may lead to end-stage renal disease in about 10% of those affected. In the LUMINA cohort the most constant feature associated with this occurrence has been ethnic affiliation. Hispanic (Amerindian, Mestizo) and patients of African descent tend to experience lupus nephritis more commonly. Renal involvement occurred in 62% of Texan Hispanic and African American patients and in

Pregnancy outcome

Although pregnancy in the lupus patient does not portend any more a very ominous prognosis, adverse pregnancy outcomes do occur, particularly if patients become pregnant when they have lingering disease activity, renal involvement, hypertension or secondary antiphopholipid syndrome. Such adverse outcomes were relatively frequent in our cohort in which 65 of 102 pregnancies which occurred after SLE had been diagnosed culminated in an adverse outcome defined as either miscarriage, pregnancy

Work disability

This is another important outcome when dealing with adults during the years they are expected to be productive members of society whether working for pay or contributing to child-care and other unpaid (and oftentimes not properly valued) home-related activities. The Kaplan–Meier survival curves for this outcome clearly indicate an association between African American and Hispanic (Texas) ethnicities and becoming work disabled over the course of the disease. However, in multivariable analyses,

Mortality and survival

We have examined this outcome several times over the years having published our results when our cohort had only 288 patients and 34 of them had died28 and subsequently with more than double the number of patients in the cohort and the number of deceased patients.29 Although the Kaplan–Meier curves clearly show statistically significant differences in the mortality experience of the ethnic groups examined with Hispanics (Texas) and African Americans having the less favorable experience, when

Conclusions

The examples described above demonstrate the importance of including measures of socioeconomic status when examining intermediate and long-term outcomes in lupus. I leave to the sociologist to determine what is the best measure or proxy of socioeconomic status is (education, income, occupation, health insurance, marital status, neighborhood, other); at least in the US, there is a tendency towards the use of geocoding or to match each patient to his/her zip code (neighborhood encompassing more

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