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. 2000 Feb;59(2):116–119. doi: 10.1136/ard.59.2.116

Racial group, socioeconomic status, and the development of persistent proteinuria in systemic lupus erythematosus

N Hopkinson 1, C Jenkinson 1, K Muir 1, M Doherty 1, R Powell 1
PMCID: PMC1753068  PMID: 10666166

Abstract

OBJECTIVES—Systemic lupus erythematosus (SLE) patients of Afro-Caribbean and Asian origin living in the United Kingdom have a more severe spectrum of disease compared with the white population but whether this is attributable to genetic host factors or environmental factors is unclear. This study examines time from first symptom to onset of persistent proteinuria, as a marker of renal disease, to assess which factors are important.
METHODS—The 189 patients studied were ascertained using multiple methods and included 161 white, 22 Afro-Caribbean and six Asian patients. Time of first observation of persistent proteinuria (⩾0.5 g/day) was taken as onset of renal SLE. Initial univariate analysis to determine which factors are associated with onset of renal disease was followed by using a Cox's proportional hazards regression model enabling analysis of several prognostic factors at the same time. Variables included three measures of socioeconomic status, ethnic group and the presence or absence of different autoantibodies.
RESULTS—There was no effect from any socioeconomic variable. Using forwards stepwise selection, the following had independent effects (p<0.05) on the development of renal SLE: Afro-Caribbean race (hazard rate ratio 4.4 (1.9-10.2), compared with white population); and the presence of IgG anti-cardiolipin antibodies (hazard rate ratio 2.6 (1.2-5.7)).
CONCLUSION—Differing socioeconomic factors do not explain the increased frequency of lupus nephritis in Afro-Caribbean patients with SLE, but rather there are important genetic or other host differences. The independent effect of IgG anti-cardiolipin antibodies warrants further investigation.



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Selected References

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  1. Christensen E. Multivariate survival analysis using Cox's regression model. Hepatology. 1987 Nov-Dec;7(6):1346–1358. doi: 10.1002/hep.1840070628. [DOI] [PubMed] [Google Scholar]
  2. Clynes R., Dumitru C., Ravetch J. V. Uncoupling of immune complex formation and kidney damage in autoimmune glomerulonephritis. Science. 1998 Feb 13;279(5353):1052–1054. doi: 10.1126/science.279.5353.1052. [DOI] [PubMed] [Google Scholar]
  3. Estes D., Christian C. L. The natural history of systemic lupus erythematosus by prospective analysis. Medicine (Baltimore) 1971 Mar;50(2):85–95. doi: 10.1097/00005792-197103000-00001. [DOI] [PubMed] [Google Scholar]
  4. Ginzler E. M., Diamond H. S., Weiner M., Schlesinger M., Fries J. F., Wasner C., Medsger T. A., Jr, Ziegler G., Klippel J. H., Hadler N. M. A multicenter study of outcome in systemic lupus erythematosus. I. Entry variables as predictors of prognosis. Arthritis Rheum. 1982 Jun;25(6):601–611. doi: 10.1002/art.1780250601. [DOI] [PubMed] [Google Scholar]
  5. Hay E. M., Croft P. Predicting outcome in current clinic attenders: a biased view. Ann Rheum Dis. 1994 Jun;53(6):357–358. doi: 10.1136/ard.53.6.357. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Hochberg M. C., Boyd R. E., Ahearn J. M., Arnett F. C., Bias W. B., Provost T. T., Stevens M. B. Systemic lupus erythematosus: a review of clinico-laboratory features and immunogenetic markers in 150 patients with emphasis on demographic subsets. Medicine (Baltimore) 1985 Sep;64(5):285–295. [PubMed] [Google Scholar]
  7. Hopkinson N. D., Doherty M., Powell R. J. The prevalence and incidence of systemic lupus erythematosus in Nottingham, UK, 1989-1990. Br J Rheumatol. 1993 Feb;32(2):110–115. doi: 10.1093/rheumatology/32.2.110. [DOI] [PubMed] [Google Scholar]
  8. Kaslow R. A. High rate of death caused by systemic lupus erythematosus among U. S. residents of Asian descent. Arthritis Rheum. 1982 Apr;25(4):414–418. doi: 10.1002/art.1780250409. [DOI] [PubMed] [Google Scholar]
  9. McAlindon T., Giannotta L., Taub N., D'Cruz D., Hughes G. Environmental factors predicting nephritis in systemic lupus erythematosus. Ann Rheum Dis. 1993 Oct;52(10):720–724. doi: 10.1136/ard.52.10.720. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Petri M., Perez-Gutthann S., Longenecker J. C., Hochberg M. Morbidity of systemic lupus erythematosus: role of race and socioeconomic status. Am J Med. 1991 Oct;91(4):345–353. doi: 10.1016/0002-9343(91)90151-m. [DOI] [PubMed] [Google Scholar]
  11. Reveille J. D., Moulds J. M., Ahn C., Friedman A. W., Baethge B., Roseman J., Straaton K. V., Alarcón G. S. Systemic lupus erythematosus in three ethnic groups: I. The effects of HLA class II, C4, and CR1 alleles, socioeconomic factors, and ethnicity at disease onset. LUMINA Study Group. Lupus in minority populations, nature versus nurture. Arthritis Rheum. 1998 Jul;41(7):1161–1172. doi: 10.1002/1529-0131(199807)41:7<1161::AID-ART4>3.0.CO;2-K. [DOI] [PubMed] [Google Scholar]
  12. Salmon J. E., Millard S., Schachter L. A., Arnett F. C., Ginzler E. M., Gourley M. F., Ramsey-Goldman R., Peterson M. G., Kimberly R. P. Fc gamma RIIA alleles are heritable risk factors for lupus nephritis in African Americans. J Clin Invest. 1996 Mar 1;97(5):1348–1354. doi: 10.1172/JCI118552. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Samanta A., Feehally J., Roy S., Nichol F. E., Sheldon P. J., Walls J. High prevalence of systemic disease and mortality in Asian subjects with systemic lupus erythematosus. Ann Rheum Dis. 1991 Jul;50(7):490–492. doi: 10.1136/ard.50.7.490. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Studenski S., Allen N. B., Caldwell D. S., Rice J. R., Polisson R. P. Survival in systemic lupus erythematosus. A multivariate analysis of demographic factors. Arthritis Rheum. 1987 Dec;30(12):1326–1332. doi: 10.1002/art.1780301202. [DOI] [PubMed] [Google Scholar]
  15. Tan E. M., Cohen A. S., Fries J. F., Masi A. T., McShane D. J., Rothfield N. F., Schaller J. G., Talal N., Winchester R. J. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982 Nov;25(11):1271–1277. doi: 10.1002/art.1780251101. [DOI] [PubMed] [Google Scholar]
  16. Ward M. M., Studenski S. Clinical manifestations of systemic lupus erythematosus. Identification of racial and socioeconomic influences. Arch Intern Med. 1990 Apr;150(4):849–853. [PubMed] [Google Scholar]
  17. Winfield J. B., Faiferman I., Koffler D. Avidity of anti-DNA antibodies in serum and IgG glomerular eluates from patients with systemic lupus erythematosus. Association of high avidity antinative DNA antibody with glomerulonephritis. J Clin Invest. 1977 Jan;59(1):90–96. doi: 10.1172/JCI108626. [DOI] [PMC free article] [PubMed] [Google Scholar]

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