Ae. Johnson et al., CROSS-SECTIONAL ANALYSIS OF THE DIFFERENCES BETWEEN PATIENTS WITH SYSTEMIC LUPUS-ERYTHEMATOSUS IN ENGLAND, BRAZIL AND SWEDEN, Lupus, 3(6), 1994, pp. 501-506
This study is a cross-sectional analysis of the differences between SL
E outpatients seen in Rheumatology departments at University centres i
n England, Brazil and Sweden, using a standard protocol. The demograph
ic characteristics, extent and activity of disease of 209 patients wit
h SLE were studied; 112 patients were seen in England, 33 in Brazil an
d 64 in Sweden. The median age of disease onset of Brazilian and Engli
sh patients was 25 years and of Swedish patients 31.5 years. Disease a
ctivity was measured by the BILAG index. In most systems Brazilian pat
ients experienced more activity than English patients and English pati
ents more activity than Swedish patients. Non-Caucasians experienced m
ore active disease than Caucasians. No sex or occupational differences
were observed in disease activity. English patients were the most lik
ely to have experienced photosensitivity, oral ulcers and haematologic
al disorders, Brazilian patients renal disorders and Swedish patients
discoid rashes. Brazilian patients were the most likely to be prescrib
ed only one drug for treatment of SLE and to be taking steroids and th
e highest dose of steroids, in contrast to the European patients who w
ere often prescribed steroids and an antimalarial agent or azathioprin
e. The results of this cross-sectional assessment of disease activity
using a standardized instrument indicate that there are real differenc
es in the extent and degree of activity of SLE in different national g
roups. This reflects a combination of genetic, environmental and socia
l influences on disease expression and has implications for treatment
and monitoring of SLE patients.