Differences in SLE disease activity between patients of Caucasian and South‐East Asian/Chinese background in an Australian hospital

Abstract

Aim: We performed a semiprospective and retrospective review of all admissions to a single institution of systemic lupus erythematosus (SLE) patients, admitted due to active disease. The aim was to describe differences in disease activity as a cause of hospital admissions between patients originating from South‐East Asia/China (SAC) and Caucasians. Method: There were 210 patients admitted for active disease, with a total of 567 admissions for active SLE over a 16‐year period. Allowing for patients who had left our database, there was a total of 3415 patient years of observation. Results: Patients from SAC with a flare requiring admission presented earlier in their disease course and with more active disease than did Caucasians (median SLE Disease Activity Index 13 vs. 8, P= 0.002). They had longer inpatient stays (7 vs. 5 days P = 0.03). There was a trend to higher rates of re‐presentation to hospital for flare (59% in SAC patients vs. 41% in Caucasians, P = 0.09) with more subsequent admissions (3 vs. 2 P = 0.06) despite a shorter period of observation. Conclusions: South‐East Asian/Chinese were more likely to be diagnosed with class III/IV glomerulonephritis and require cyclophosphamide both at presentation and subsequent admissions. More patients from SAC were readmitted to hospital for severe central nervous system disease after their first hospital admission. In this population, lupus patients had more severe flares and more frequently required admission for these than Caucasians.

A systematic review of prevalence, disease characteristics and management of systemic lupus erythematosus in Australia: identifying areas of unmet need

“…Information retrieved on patient outcomes, including mortality and complications of pregnancy, was also limited. Several studies reported instances of death due to sepsis/infection, consistent with a recent meta‐analysis, which identified that the standardised mortality rate due to infection was increased in patients with SLE compared with the general population . The meta‐analysis also revealed that patients with SLE had an increased risk of death due to cardiovascular and renal disease .…”

“…Other special populations studied were Asian Australians and pregnant women. Two studies reported that Asian Australians were more affected by SLE than non‐Asian Australians in terms of disease severity, renal involvement, photosensitivity, laboratory characteristics and flares . One narrative review also discussed evidence for greater SLE severity among patients of Asian ethnicity, although no Australian data were presented .…”

Response to Nonsteroidal Anti-inflammatory Drugs in African Americans with Osteoarthritis of the Knee

“…Studies in systemic lupus erythematosus indicate that the incidence of disease flares differs across ethnic groups: some reports suggest that patients of Southeast Asian ethnicity are more likely to experience disease flares than those of white ethnicity. 49 Although there are currently no known studies in arthritic patients, differences in disease flares between ethnic/racial groups may provide a plausible explanation for the response to treatment seen in the African American patients enrolled in the present study. Flare intensity may be an important determinant of treatment outcome, and should be taken into consideration when evaluating trial findings.…”

Asian ethnicity in systemic lupus erythematosus: an Australian perspective

“…There are no published studies that document differences in a single disease activity instrument between Asian and Caucasian patients in a single cohort; clearly, this is an area where additional research is needed. Circumstantial evidence such as the increased use of immunosuppressive agents in Asian patients further supports the notion of Asian lupus patients having more overall active disease . Boers et al .…”