SYSTEMIC LUPUS-ERYTHEMATOSUS IN AUSTRALIAN ABORIGINES - HIGH PREVALENCE, MORBIDITY AND MORTALITY

Background. Racial differences occur in the incidence of systemic lupu s erythematosus (SLE). It has been suggested that SLE occurs at a high er prevalence an with greater severity in Aboriginal Australians, but because of the small, widely distributed population base, this has not been well documented. Aims: To confirm and document the clinical impr ession of an increased prevalence and severity of systemic lupus eryth ematosus (SLE) in Aboriginal Australians, and to identify prognostic i ndicators. Methods: Top End Northern Territory (NT) Aborigines with SL E on 1 January 1984 or diagnosed thereafter were followed until 1 Janu ary 1991. Epidemiological, clinical and serological data were collecte d. Results: Prevalence on 1 January 1991 estimated at 1: 1900, at leas t twice the estimated prevalence in non-Aboriginal Australians. High f requencies of renal disease (62% with proteinuria > 0.5 g/day) and aut oantibodies to the Sm antigen (29%) were identified, contributing to t he high mortality. Five year survival rate was 60%, with 67% of deaths resulting from infection. Conclusions: There is a high prevalence of SLE in NT Aborigines. In view of probable under-recognition of mild ca ses the true prevalence is likely to be even higher. Although morbidit y and mortality may have been overestimated for the same reason, both were found to be high. Improved living conditions and health care deli very may improve prognosis.