OUTCOME OF SYSTEMIC LUPUS ERYTHEMATOSUS IN MINORITIES--NATURE VS NURTURE

为了确定遗传、社会经济-人口统计学和行为-文化因素对三个种族的系统性红斑狼疮（SLE）患者结局的相对影响，我们组成了一个病程相对较短（最初诊断为SLE后5年内）的SLE患者队列[根据美国流变学会或（ACR）标准]。 我们跟踪了这一队列，以确定三个具体的结果，疾病活动，疾病损害和功能（身体和精神）。 到目前为止，我们已经获得并分析了从疾病发作到研究两年的数据。在我们的重要结果中，我们发现种族，除了迄今为止所研究的遗传特征之外，（MHC II类和III类基因和CR1大小和表达多态性）影响疾病特征和早期活动，而在病程后期，社会经济-人口统计学特征似乎是疾病活动、损害和功能的重要调节剂;疾病活动与损害之间的关系很重要，但随着时间的推移，疾病活动受到缺乏健康保险、无助和社会支持不足的显著影响;在这三个种族群体中，损害并不均匀地累积，但在V2时，这种差异刚刚变得明显。 最后，尽管疾病活动和疾病损害的差异，自我感知的身体和精神功能受损的方式在这三个种族群体。 为了确定不同变量对SLE病程和结局的贡献，随着疾病进展和器官损害的累积，我们认为有必要扩大我们的观察范围，并将目前的队列扩大到包括新诊断的患者，以便我们有足够的能力来评估可能的预测结果因素，我们以前没有足够的力量。 因此，我们的具体目标如下：1）继续对已建立的LUMINA队列的所有成员进行年度确认访问。 2)招募符合上述相同标准的新患者进入LUMINA队列。 3)检测以前未检测的其他MHC和非MHC遗传因素，以确定其对SLE病程和结局的影响，特别是TNF、甘露糖结合蛋白（MBP）、IL-1受体拮抗剂（IL 1-RA）和Bcl-2。4)完善对迄今为止发现是疾病活动、损害和功能的重要预测因素的临床和行为文化因素的评估。 5)利用先进的统计分析技术，研究疾病活动性、疾病损害与这些患者的身心功能之间的关系。

In an effort to determine the relative impacts of genetic, socioeconomic- demographic and behavioral-cultural factors on outcome in systemic lupus erythematosus (SLE) among patients from three ethnic groups, we have constituted a cohort of patients with SLE [as per the American College of Rheumatology or (ACR) criteria] of relatively short duration (initially within five years of diagnosis). We have followed this cohort to determine three specific outcomes, disease ACTIVITY, disease DAMAGE, & FUNCTIONING (physical and mental). Thus far, we have obtained and analyzed the data gathered from disease onset to two years into the study. Among our importnt results, we have found that ethnicity, over and above the genetic features examined so far (MHC Class II and III genes and CR1 size and expression polymorphisms) influences disease features and activity early on, whereas later in the course, socioeconomic-demographic features appear to be important modulators of disase activity, damage and functioning; the relationship between disease activity and damage is important, but disease activity over time is significantly influenced by lack of health insurance, helplessness and poor social support; damage does not accrue uniformly across the three ethnic groups but the divergence is just becoming apparent at V2. Finally, despite differences in disease activity and disease damage, self-perceived physical and mental functioning are impaired in a comparable manner in these three ethnic groups. In order to determine the contributions of different variables to the course and outcome of SLE, as the disease progresses and organ damage accumulates, we think it is imperative we extend our observations as well as expand the present cohort to include newly diagnosed patients so that we would have sufficient power to evaluate possible predictive outcome factors for which we did not have sufficient power previously. Our specific aims are thus the following: 1) To continue yearly ascertainment visits of all members of the established LUMINA cohort. 2) To recruit into the LUMINA cohort new patients meeting the same criteria as noted above. 3) To examine additional MHC and non-MHC genetic factors not previously examined to determine their impact on the course and outcome of SLE, specifically TNF, mannose binding protein (MBP), IL-1 receptor antagonist (IL1-RA) and Bcl-2. 4) To refine the assessment of those clinical and behavioral-cultural factors found to be important predictors of disease activity, damage and functioning, thus far. 5) To study the relationships among disease activity, disease damage and physical and mental functioning in these patients as the disease progresses utilizing sophisticated statistical analytical techniques.