Ann Rheum Dis 2000;59:116-119 ( February )

Extended report

Racial group, socioeconomic status, and the development of persistent proteinuria in systemic lupus erythematosus N D Hopkinson^a, C Jenkinson^b, K R Muir^b, M Doherty^d, R J Powell^c

^a Department of Rheumatology, Royal Bournemouth and Christchurch Hospitals, Castle Lane East, Bournemouth BH7 7DW, ^b Department of Public Health Medicine and Epidemiology, Queen's Medical Centre, Nottingham, ^c Clinical Immunology Unit, Queen's Medical Centre, ^d Academic Rheumatology, Clinical Sciences Building, City Hospital, Nottingham

Correspondence to: Dr Hopkinson

Accepted for publication 28 October 1999

OBJECTIVESSystemic lupus erythematosus (SLE) patients of Afro-Caribbean and Asian origin living in the United Kingdom have a more severe spectrum of disease compared with the white population but whether this is attributable to genetic host factors or environmental factors is unclear. This study examines time from first symptom to onset of persistent proteinuria, as a marker of renal disease, to assess which factors are important.
METHODSThe 189 patients studied were ascertained using multiple methods and included 161 white, 22 Afro-Caribbean and six Asian patients. Time of first observation of persistent proteinuria (0.5 g/day) was taken as onset of renal SLE. Initial univariate analysis to determine which factors are associated with onset of renal disease was followed by using a Cox's proportional hazards regression model enabling analysis of several prognostic factors at the same time. Variables included three measures of socioeconomic status, ethnic group and the presence or absence of different autoantibodies.
RESULTSThere was no effect from any socioeconomic variable. Using forwards stepwise selection, the following had independent effects (p<0.05) on the development of renal SLE: Afro-Caribbean race (hazard rate ratio 4.4 (1.9-10.2), compared with white population); and the presence of IgG anti-cardiolipin antibodies (hazard rate ratio 2.6 (1.2-5.7)).
CONCLUSIONDiffering socioeconomic factors do not explain the increased frequency of lupus nephritis in Afro-Caribbean patients with SLE, but rather there are important genetic or other host differences. The independent effect of IgG anti-cardiolipin antibodies warrants further investigation.

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© 2000 by Annals of the Rheumatic Diseases
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