OUTCOME OF SYSTEMIC LUPUS ERYTHEMATOSUS IN MINORITIES

描述（取自应用程序） 当然，遗传和非遗传因素都会导致这种倾向。 和系统性红斑狼疮（SLE）的结局。 我们已经建立了一个 来自三个种族的229名SLE患者（西班牙裔， 非裔美国人和高加索人）在两个地理位置（亚拉巴马和 为了研究的相对重要性， 社会经济-人口、行为-文化和免疫遗传学特征 SLE的临床表现。 在发病时，我们发现 免疫遗传和种族因素是疾病的主要原因 SLE的活动和特定器官表现（肾脏、神经精神 心脏）。 在研究开始时，西班牙裔和非洲裔美国人表现出 疾病活动水平更高。 缺乏私人保险，突然 疾病发作、抗Ro抗体、缺乏HLA-DR 3和异常疾病 行为，也预示着更大的疾病活动。 在一项为期两年的研究中， 无助、社会支持差和缺乏健康保险的预测 在研究期间持续的疾病活动。 正如所预料的那样， 持续性疾病活动作为单因素最佳预测疾病 损害 随着时间的推移，我们注意到不同的损坏率 在三个种族组中，非高加索人的疾病发生率更高， 相关的后果，虽然差异尚未统计 显著 尽管如此，自我感知功能在 三组 特别值得注意的是，种族本身，独立于 迄今为止测量的遗传因素，以及社会经济-人口和 行为文化因素，预测持续性疾病活动和 损害，这表明其他遗传因素正在影响 SLE。 在本次提交的文件中，我们建议：1）继续遵循目前的做法 队列：2）将当前队列从229例患者扩大至450例患者， 来提高我们发现这三者之间有意义的差异的能力 种族群体; 3）检查其他MHC和非MHC基因，这些基因也 与SLE相关（TNF，MBP，IL 1-RA，Bcl-2）; 4） 对那些临床、行为文化因素的评估发现， 疾病活动、损害和自我感知的重要预测因素 5）研究疾病活动之间的关系， 这些患者的疾病损害和自我感知功能， 疾病的进展和预测它们的因素。 随访时间更长 我们预计，疾病的影响将显着不同， 这三个民族，加上新的病人招募，我们 期望有能力检测社会经济人口统计学，临床， 免疫遗传学和行为文化因素促成这些 差异

DESCRIPTION (Taken from the application) Both genetic and nongenetic factors contribute to the predisposition, course and outcome of systemic lupus erythematosus (SLE). We have constituted a cohort of 229 SLE patients from three ethnic groups (Hispanics, African-Americans and Caucasians) at two geographic locations (Alabama and Texas) in order to examine the relative importance of socioeconomic-demographic, behavioral-cultural and immunogenetic features in the clinical manifestations of SLE over time. At disease onset, we found that immunogenetic and ethnic factors primarily accounted for disease activity and specific organ manifestations of SLE (renal, neuropsychiatric and cardiac). At study entry, Hispanics and African-Americans exhibited higher levels of disease activity. Lack of private insurance, abrupt disease onset, anti-Ro antibodies, lack of HLA-DR3 and abnormal illness behaviors, also predicted greater disease activity. Two years into a study, helplessness, poor social support and lack of health insurance predicted persistent disease activity over the study duration. As expected, persistent disease activity as a single factor best predicted disease damage. As more time passes, we are noticing a differential rate of damage accrual in the three ethnic groups, with non-Caucasians having more disease related consequences, although the differences are not yet statistically significant. Despite this, self-perceived functioning was similar in the three groups. Of particular note was that ethnicity per se, independent of genetic factors measured thus far, and socioeconomic-demographic and behavioral-cultural factors, predicted both persistent disease activity and damage, suggesting that other genetic factors are affecting the course of SLE. In this submission, we propose: 1) to continue following the present cohort: 2) to enlarge the present cohort from 229 to 450 patients in order to increase our ability to detect meaningful differences between the three ethnic groups; 3) to examine additional MHC-and non-MHC genes that have also been associated with SLE (TNF, MBP, IL1-RA, Bcl-2); 4) to refine the assessment of those clinical, behavioral-cultural factors found to be important predictors of disease activity, damage and self-perceived functioning thus far; 5) to study the relationship among disease activity, disease damage and self-perceived functioning in these patients as the disease progresses and the factors that predict them. With longer follow-up we expect the impact of the disease will be significantly different among the three ethnic groups and with the addition of new patient recruits we expect to have the power to detect the socioeconomic-demographic, clinical, immunogenetic and behavioral-cultural factors contributing to these differences.