SYSTEMIC LUPUS-ERYTHEMATOSUS IN 3 ETHNIC-GROUPS - II - FEATURES PREDICTIVE OF DISEASE-ACTIVITY EARLY IN ITS COURSE

Objective. To determine the factors associated with disease activity i n patients with recent-onset (less than or equal to 5 years) systemic lupus erythematosus (SLE) who were of Hispanic, African-American, or C aucasian ethnicity. Methods. Incident and prevalent cases of SLE, as d efined by the American College of Rheumatology criteria for SLE, among the 3 ethnic groups were identified in Alabama (The University of Ala bama at Birmingham) and Texas (The University of Texas-Houston Health Science Center and The University of Texas Medical Branch at Galveston ), Variables from the sociodemographic, clinical, immunologic, immunog enetic, behavioral, and psychological domains were obtained using vali dated instruments. Disease activity was ascertained with the Systemic Lupus Activity Measure (SLAM), Stepwise domain regressions with SLAM s core as the dependent variable were performed. Final ethnic-specific a nd overall regression models were obtained by entering variables that were retained in the domain regressions. Results, SLAM scores at study entry were higher in the African Americans (mean +/- SD 12.6 +/- 6.9) and Hispanics (11.0 +/- 6.2) than in the Caucasians (8.5 +/- 3.7) (P less than or equal to 0.001). The final overall regression model (R-2 = 28%) for higher SLAM score included the following variables: African -American ethnicity, lack of private health insurance, abrupt disease onset, presence of anti-ao antibodies, absence of HLA-DRB10301, highe r levels of helplessness, and abnormal illness-related behaviors, Conc lusion. Socioeconomic, immunologic, immunogenetic, behavioral, and psy chological variables were all predictive of disease activity early in the course of SLE, irrespective of ethnic group. However, there remain ethnic group differences in disease activity that were not explained by these factors.