Association of Asian ethnicity with disease activity in SLE: an observational study from the Monash Lupus Clinic

Golder, Vera; Connelly, Kathryn; Staples, Margaret; Morand, Eric Francis; Hoi, Alberta

doi:10.1177/0961203313500547

Cited by 63 publications

(87 citation statements)

References 28 publications

(42 reference statements)

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“…As previously reported,20 21 patients in this cohort had evidence of active disease and of serological activity, with 97% receiving immunosuppressant drugs during follow-up and a mean daily dose of prednisolone of 7.07 mg (table 2). We analysed 3352 visits, representing a mean (SD) of 17.5 (11.7) visits per patient over 3.9 (2.0) years of follow-up (table 3).…”

Section: Resultssupporting

confidence: 67%

“…The data set comprised a prospective longitudinal observational cohort of patients with SLE established in 2007 in Melbourne, Australia, as described 20 21. Patients assessed between 2007 and 2012 who met the American College of Rheumatology (ACR) 1997 classification criteria for lupus22 were eligible for inclusion if they were over 18 years of age, were competent to provide informed consent, had been seen on at least two occasions, and had at least one SDI completed.…”

Section: Methodsmentioning

confidence: 99%

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Definition and initial validation of a Lupus Low Disease Activity State (LLDAS)

et al. 2015

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Section: Resultssupporting

confidence: 67%

Section: Methodsmentioning

confidence: 99%

Definition and initial validation of a Lupus Low Disease Activity State (LLDAS)

et al. 2015

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“…In a singlecentre longitudinal cohort, the prevalence of renal disease, high titres of antidsDNA anti bodies and overall disease activity, were substantially higher in ethnic Asian patients than in patients of white European heritage. 34 The causes, pre sumably genetic, of increased SLE severity in Asian Australians are not yet known, but must be taken in the context of other poten tial contributors to health outcomes of the migrant experience, such as cultural factors and health literacy.…”

Section: Indigenous and Migrant Populationsmentioning

confidence: 99%

Successes, challenges and developments in Australian rheumatology

Morand

Leech

2015

Nat Rev Rheumatol

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Australia is a geographically vast but sparsely populated country with many unique factors affecting the practice of rheumatology. With a population comprising minority Indigenous peoples, a historically European-origin majority population, and recent large-scale migration from Asia, the effect of ethnic diversity on the phenotype of rheumatic diseases such as systemic lupus erythematosus (SLE) is a constant of Australian rheumatology practice. Australia has a strong system of universal healthcare and subsidized access to medications, and clinical and research rheumatology are well developed, but inequitable access to specialist care in urban and regional centres, and the complex disconnected structure of the Australian healthcare system, can hinder the management of chronic diseases.

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“…In a large single-center US LN cohort [41], the mean Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score predicted mortality and organ damage including renal damage, and a higher SLEDAI score was associated with African American ethnicity. In a single-center Australian study [42], Asian ethnicity was associated with more severe SLE, a higher mean and maximum SLEDAI score, a more frequent persistently active disease and renal disease and also a higher proportion of positivity of different autoantibodies (anti-ds-DNA, anti-Ro, anti-La, anti-RNP and anti-Sm), more frequent hypocomplementemia and immunosuppressant use. …”

Section: Ethnicity and Outcome Of Sle And Lnmentioning

confidence: 99%

Lupus Nephritis: A Different Disease in European Patients?

Tesař

Hrušková²

2015

Kidney Dis

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Background: Lupus nephritis (LN) is still associated with significant mortality and substantial risk of progression to end-stage renal failure. Its outcome is related to the class and severity of LN and response to treatment, and it is poorer in patients with renal relapses. Ethnicity has a relatively well-defined impact on the outcome of the patients and their response to treatment and must always be taken into consideration in treatment decisions. Summary: In this article, we provide a review of the impact of ethnicity on the prevalence of systemic lupus erythematosus (SLE), the proportion of patients with SLE developing LN, outcomes of SLE and LN and response of LN to treatment. In European patients, the prevalence of SLE and the proportion of SLE patients with LN are lower and the outcome of LN is better than in nonwhite populations. European patients may respond better to some modes of treatment [e.g. cyclophosphamide (CYC) or rituximab] and may be less frequently refractory to treatment compared to black patients with LN. Although these differences may be largely genetically driven, socioeconomic factors (poverty, education, insurance, access to health care and adherence to treatment) may also play a significant role in some disadvantaged patients. Key Message: Treatment of LN may be different in patients with different ethnicity. Less aggressive disease in European patients may better respond to less aggressive treatment. Treatment of LN in nonwhite patients may require newer (more effective) therapeutic approaches, but targeting negative socioeconomic factors might be even more effective. Facts from East and West: (1) The prevalence of SLE is lower among Caucasians than other ethnicities. A higher prevalence is observed among Asians and African Americans, while the highest prevalence is found in Caribbean people. The prevalence of LN in Asian SLE patients is much higher than in Caucasians as well. However, the 10-year renal outcome and renal survival rate appear to be better in Asians. (2) Polymorphisms of genes involved in the immune response, such as Fcγ receptor, integrin alpha M, TNF superfamily 4, myotubularin-related protein 3 and many others, might be partly responsible for the differences in prevalence between the different ethnic groups. European ancestry was shown to be associated with a decrease in the risk of LN even after adjustment for genes most associated with renal disease. (3) Access to health care is a key determinant of disease progression, treatment outcome and the management of complications such as infections, particularly in South Asia, and might also explain disparities between clinical outcomes. (4) The efficacy of low-dose CYC combined with corticosteroids for induction treatment of LN was proved in European Caucasian patients. This treatment is also used in Asia, although no formal evaluation of efficacy and safety in comparison with other treatment regimens exists in this population. The efficacy of mycophenolate mofetil (MMF) is similar to that of CYC, and similar between Asi...

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Association of Asian ethnicity with disease activity in SLE: an observational study from the Monash Lupus Clinic

Abstract: In this single-cohort study, Asian ethnicity was found to be associated with increased SLE disease activity. This suggests significant inter-ethnic genetic contributions to the regulation of autoimmune responses and disease severity in SLE.

Cited by 63 publications

References 28 publications

Definition and initial validation of a Lupus Low Disease Activity State (LLDAS)

Definition and initial validation of a Lupus Low Disease Activity State (LLDAS)

Successes, challenges and developments in Australian rheumatology

Lupus Nephritis: A Different Disease in European Patients?

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