Systemic lupus erythematosus in the far north of Queensland

Abstract

An assessment of prevalence for systemic lupus erythematosus (SLE) has been attempted for the population of far north Queensland in Australia. This huge area has a majority Caucasian population living in a tropical environment. Roughly 10% of the population comprises people of Australian Aboriginal or Torres Strait Islander descent. The prevalence of disease was high (45.3 per 100000) overall and particularly so in the indigenous population (92.8 per 100000) where the disease appears to be more severe. The pattern of organ involvement and laboratory anomalies did not vary between the populations examined. Disease duration however was different, being longer by comparison in the Caucasian population due to many premature deaths in the indigenous groups. The reasons for such high prevalence figures and some problems encountered in practice are discussed.

Focus on systemic lupus erythematosus in Indigenous Australians: towards a better understanding of autoimmune diseases

“…Differences in SLE prevalence, biological and clinical phenotypes were reported in a study comparing IA from Northern Queensland and metropolitan Sydney, 14 potentially reflecting differences in environmental factors such as ultraviolet radiation exposure and the prevalence of infection. 13,32 The higher prevalence of SLE in Northern Territory IA was reported to be associated with a higher occurrence of C4 null alleles, 33 but this was not confirmed in another study. 34 The incomplete penetrance of SLE in one IA family with a 5% prevalence of SLE 32 suggests an interaction between genetic factors promoting an autoimmune susceptibility, and environmental factors, such as skin infections and high ambient ultraviolet radiation exposure, as a trigger.…”

“…6 SLE prevalence is higher among African-Americans, 7 African-Caribbeans, 8,9 Hispanics, 7 Asians, 8,10 North American Indians 11 and Indigenous Australians (IA). [12][13][14][15][16] Differences in socio-economic status (SES) do not explain the increased frequency of lupus nephritis in African-Caribbean patients, 17 and are less important than genetic factors to explain ethnic disparity in lupus nephritis. 18 Although the current underprivileged SES of IA has a negative impact on quality of life, the effect of SES on SLE in IA is unknown.…”

Renal histology in Indigenous Australians with lupus nephritis

“…5 The reasons for this increased risk of death and progression to ESRD are likely multifactorial; the majority of our IA cohort belonged to disadvantaged communities, where low socio-economic status, poor compliance and a high prevalence of comorbidity such as arterial hypertension and diabetes mellitus impact on the prognosis. 18,23 The observed survival disparity is not unique to LN as it is also seen in IA patients with cancer or receiving renal replacement therapy. [24][25][26][27] The fact that LN class and renal activity index or serological disease measures were not predictive of renal survival strongly suggests that factors other than histological LN severity contribute to this poor renal prognosis.…”

Successes, challenges and developments in Australian rheumatology

“…In Indigenous Australians, the reported prevalence of SLE varies from 52.6-92.8 per 100,000 people, a prevalence 2-4fold higher than in white Australians of European descent. [25][26][27][28][29] Moreover, the severity of SLE, as well as associated mortality rates, are high in Indigenous Australian popu lations. 25,26,29 For example, endstage renal disease resulting from lupus nephritis is almost 3fold more common among Indigenous Australians compared with the rest of the population.…”

“…[25][26][27][28][29] Moreover, the severity of SLE, as well as associated mortality rates, are high in Indigenous Australian popu lations. 25,26,29 For example, endstage renal disease resulting from lupus nephritis is almost 3fold more common among Indigenous Australians compared with the rest of the population. 30 A potential contributor to the increased preva lence of SLE in Indigenous Australians is the high incidence of infections in Indigenous Australian communities; 24 studies of other potential risk factors (such as complement deficiency) are inconclusive.…”