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Differences by race, sex and age in the clinical and immunologic features of recently diagnosed systemic lupus erythematosus patients in the southeastern United States

Epidemiology Branch A3-05, NIEHS, PO Box 12233, Durham, NC 27709, USA. cooper1{at}niehs.nih.gov

C G Parks

Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, North Carolina, USA

E L Treadwell

Division of Rheumatology, East Carolina University School of Medicine, Greenville, North Carolina, USA

E W St Clair

Division of Rheumatology, Allergy, and Clinical Immunology, Duke University Medical Center, Durham, North Carolina, USA

G S Gilkeson

Medical Research Service, Ralph H Johnson Veterans Administration Medical Center and the Medical University of South Carolina, Charleston, South Carolina, USA

P L Cohen

Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA

R A S Roubey

M A Dooley

Division of Rheumatology and Immunology, Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA

We examined the prevalence of clinical and immunologic features of systemic lupus erythematosus (SLE) by race, sex and age in a population-based study of 265 SLE patients. Patients ful" lled the American College of Rheumatology classi" cation criteria. The median time between diagnosis and study enrollment was 13 months. The clinical and hematologic data were limited to occurrences up to 6 months after the diagnosis date, as documented in medical records. We used sera collected at study enrollment from 244 (92%) patients for serologic testing of autoantibodies. The associations between clinical and immunological features of SLE and age, sex and race were examined using logistic regression. The effect of each of these variables was examined adjusting for the other two demographic factors. Mean age at diagnosis was 6 years younger among African-Americans and other minorities compared with white patients (P < 0.01). Discoid lupus, proteinuria, anti-Sm and anti-RNP autoantibodieswere more commonly seen in African-American patients, with odds ratios higher than 3.0. Photosensitivity and mucosal ulcers were noted less often in African-American patients. Proteinuria, leukopenia, lymphopenia and thrombocytopenia were approximately three times more common in men compared with women. The prevalence of oral or nasal ulcers and antiDNA autoantibodies declined with age. The extent to which the differences we observed re‘ ect genetic or environmental in‘ uences on the disease process should be investigated.

Key Words: lupus • demographics • age • sex • race • autoantibodies

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