I too, am America: a review of research on systemic lupus erythematosus in African-Americans

Abstract

Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disorder that can cause significant morbidity and mortality. A large body of evidence has shown that African-Americans experience the disease more severely than other racial-ethnic groups. Relevant literature for the years 2000 to August 2015 were obtained from systematic searches of PubMed, Scopus, and the EBSCOHost platform that includes MEDLINE, CINAHL, etc. to evaluate research focused on SLE in African-Americans. Thirty-six of the 1502 articles were classified according to their level of evidence. The systematic review of the literature reported a wide range of adverse outcomes in African-American SLE patients and risk factors observed in other mono and multi-ethnic investigations. Studies limited to African-Americans with SLE identified novel methods for more precise ascertainment of risk and observed novel findings that hadn't been previously reported in African-Americans with SLE. Both environmental and genetic studies included in this review have highlighted unique African-American populations in an attempt to isolate risk attributable to African ancestry and observed increased genetic influence on overall disease in this cohort. The review also revealed emerging research in areas of quality of life, race-tailored interventions, and self-management. This review reemphasizes the importance of additional studies to better elucidate the natural history of SLE in African-Americans and optimize therapeutic strategies for those who are identified as being at high risk.

Use of SLICC criteria in a large, diverse lupus registry enables SLE classification of a subset of ACR-designated subjects with incomplete lupus

“…In the absence of racially informed reference values, the leucopenia/lymphopenia criterion may lead to misclassification of patients with benign leucopenia of ethnicity; this highlights the need to consider racial diversity when developing and applying SLE classification criteria. 15 Disease severity did not differ between SLE SLICC-only and SLE ACR-only subjects, based on major organ system involvement and medication history. Along with a trend for increased major immunosuppressant use, SLE SLICC-only subjects presented several features associated with increased risk for morbidity and mortality, including a marginally higher proportion of minority subjects and increased prevalence of thrombocytopenia, anti-dsDNA and anticardiolipin responses compared with SLE ACR-only .…”

Ethnic benign neutropenia: A phenomenon finds an explanation

“…Another study noted that incident rates of Graves' disease were significantly higher in black women and men compared with whites, but no relation to the Duffy‐null/ ACKR1 SNP were reported . In systemic lupus erythematosus (SLE), there is some evidence that African Americans experience the disease more severely than other racial‐ethnic groups . So, no clear conclusion can be drawn as to EPN and autoimmune disorders.…”

“…32 In systemic lupus erythematosus (SLE), there is some evidence that African Americans experience the disease more severely than other racial-ethnic groups. 33 So, no clear conclusion can be drawn as to EPN and autoimmune disorders.…”

Treating Systemic Lupus Erythematosus (SLE): The Impact of Historical Environmental Context on Healthcare Perceptions and Decision-Making in Charleston, South Carolina

“…In the United States, the highest lupus morbidity and mortality rates are among African-American women [13][14][15]. Systemic lupus erythematosus (SLE) affects approximately 1 in 250 African-American women of childbearing age, and African Americans overall have three to four times greater prevalence of lupus; risk of developing lupus at an earlier age; and lupus-related disease activity, damage, and mortality compared with Caucasians [16][17][18][19][20].…”