Alarcón G S, McGwin G, Bartolucci A A, Roseman J, Lisse J, Fessler B J, Bastian H M, Friedman A W, Reveille J D
The University of Alabama at Birmingham 35294, USA.
Arthritis Rheum. 2001 Dec;44(12):2797-806. doi: 10.1002/1529-0131(200112)44:12<2797::aid-art467>3.0.co;2-9.
To determine the factors predictive of damage in a multiethnic (Hispanic, African American, and Caucasian) LUMINA (lupus in minority populations, nature versus nurture) cohort of patients with systemic lupus erythematosus (SLE) with disease duration of < or =5 years at enrollment (T0).
Variables (socioeconomic/demographic, clinical, immunologic, immunogenetic, behavioral, and psychological) were measured at T0 and annually thereafter. Disease damage was measured with the Systemic Lupus International Collaborating Clinics Damage Index (SDI), and disease activity was measured with the Systemic Lupus Activity Measure. The relationship between the different variables and the SDI at the last visit (TL) was examined (mean followup from diagnosis to TL 61 months; adjusted for disease duration). Poisson regression was used to identify the independent association between the different variables and SDI scores at TL.
Seventy-two Hispanics, 104 African Americans, and 82 Caucasians were included. One-half of patients had not accrued any damage. Caucasians had the lowest SDI scores at T0, and Hispanics had the highest scores at TL. Renal damage occurred more frequently among Hispanics and African Americans, while integument damage was more frequent among African Americans. Neuropsychiatric (20%), renal (16%), and ocular (15%) damage occurred most frequently among all patients. Independent predictors of SDI at TL were age, corticosteroid use (maximum dose at T0), number of American College of Rheumatology (ACR) criteria met, disease activity, and abnormal illness-related behaviors. Other variables were less consistently associated with damage accrual (poverty in African Americans, lack of HLA-DRB10301 in Hispanics, presence of HLA-DQB10201 and acute onset of SLE in Caucasians).
Damage in SLE occurs from the outset in some, but not all, patients; Hispanics accrue damage more rapidly. Disease factors (corticosteroid use, number of ACR criteria met, disease activity, and acute-onset type) are important, but age and abnormal illness-related behaviors also contribute to overall damage in SLE.
确定在一个多民族（西班牙裔、非裔美国人和白种人）的LUMINA（少数族裔人群中的狼疮，先天与后天）队列中，系统性红斑狼疮（SLE）患者在入组时（T0）病程小于或等于5年的情况下，预测损伤的因素。
在T0时及之后每年测量变量（社会经济/人口统计学、临床、免疫、免疫遗传学、行为和心理方面）。用系统性红斑狼疮国际协作临床损伤指数（SDI）测量疾病损伤，用系统性狼疮活动度量表测量疾病活动度。检查不同变量与最后一次随访（TL）时的SDI之间的关系（从诊断到TL的平均随访时间为61个月；对病程进行了校正）。采用泊松回归来确定不同变量与TL时SDI评分之间的独立关联。
纳入了72名西班牙裔、104名非裔美国人和82名白种人。一半的患者未出现任何损伤。白种人在T0时的SDI评分最低，而西班牙裔在TL时的评分最高。西班牙裔和非裔美国人中肾脏损伤更为常见，而非裔美国人中皮肤损伤更为常见。神经精神（20%）、肾脏（16%）和眼部（15%）损伤在所有患者中最为常见。TL时SDI的独立预测因素为年龄、皮质类固醇使用情况（T0时的最大剂量）、符合美国风湿病学会（ACR）标准的数量、疾病活动度以及异常的疾病相关行为。其他变量与损伤累积的关联不太一致（非裔美国人中的贫困、西班牙裔中缺乏HLA - DRB10301、白种人中存在HLA - DQB10201以及SLE急性起病）。
SLE中的损伤在一些但并非所有患者中从疾病一开始就出现；西班牙裔患者损伤累积更快。疾病因素（皮质类固醇使用、符合ACR标准的数量、疾病活动度和急性起病类型）很重要，但年龄和异常的疾病相关行为也会导致SLE的总体损伤。
