Lupus is More Severe in Racial/Ethnic Minorities

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Racial and ethnic minority patients with lupus develop more kidney, neurological, and blood manifestations than their white counterparts, according to new research.

In a study published in a recent Arthritis Care & Research issue, investigators discovered black, Asian/Pacific Islander, and Hispanic lupus patients experience these problems sooner after disease diagnosis. This is the first epidemiologic study to compare lupus manifestation among major racial and ethnic groups.

“This study found important differences in the characteristics and progression of lupus between racial and ethnic minority groups and whites,” said study author Ernest Maningdeng, M.D., MPH, a University of California at San Francisco epidemiologist. “Data collected in this study support the importance of increased awareness of lupus and its accelerated progression by clinicians for these racial and ethnic groups.”

To determine manifestation differences, researchers retrospectively identified affected patients in a large electronic medical records database. Investigators identified 724 patients across four racial/ethnic groups:  white (26.2 percent), black (18.8 percent), Asian Pacific Islander (36.9 percent), and Hispanic (15.5 percent).

Based on data analysis, researchers determined black, Asian Pacific Islander, and Hispanic patients all had a greater prevalence of kidney abnormalities than white patients. Additionally, black patients experienced increased neurological manifestations, and both black and Asian Pacific Islander patients had more blood manifestations than white counterparts.

Findings also revealed racial and ethnic group patients had a greater risk of developing many severe manifestations, including lupus nephritis, thrombocytopenia, and antiphospholipid syndrome, earlier than white patients. In fact, the lupus nephritis risk is highest during the first post-diagnosis year with Asian Pacific Islander patients experiencing the most risk.

Investigators hypothesized several reasons why racial and ethnic groups have greater lupus nephritis risks. Certain genotypes increase the risk among black patients, and socioeconomic factors could affect black and Hispanic patients, they said.

Additionally, results revealed male patients were more likely to have organ damage, have a higher lupus nephritis risk than women, and develop thrombocytopenia earlier. Researchers postulated sex hormones and a reluctance to seek medical care could play into gender differences in lupus presentation.

Ultimately, investigators said, they hope the findings can support earlier diagnosis and treatment options.

There were a number of limitations associated with the study, such as the possibility of incomplete case information and the quality of information available in patient records which were not standardized.

See related article:  "Early Diagnosis and Treatment of Lupus Essential in Racial/Ethnic Populations"

REFERENCE

Maningding E, Dall’Era M, Turpin L, Murphy L, Yazdany J, Racial/Ethnic Differences in Prevalence of and Time to Onset of SLE Manifestations: The California Lupus Surveillance Project (CLSP), Arthritis Care & Research (2019), doi: 10.1002/acr.23887