Kheir Joseph M, Guthridge Carla J, Johnston Jonathon R, Adams Lucas J, Rasmussen Astrid, Gross Timothy F, Munroe Melissa E, Bourn Rebecka L, Sivils Kathy L, Guthridge Joel M, Weisman Michael H, Wallace Daniel J, Anaya Juan-Manuel, Rojas Villarraga Adriana, Jarvis James N, Harley John B, James Judith A
Department of Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.
Oklahoma State University Health Sciences Center, Tulsa, Oklahoma, USA.
Lupus Sci Med. 2018 Feb 27;5(1):e000247. doi: 10.1136/lupus-2017-000247. eCollection 2018.
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with varied morbidity and mortality. We assessed clinical presentations, autoantibody specificities and therapeutic interventions in Native American (NA) patients with SLE.
Patients with SLE meeting 1997 American College of Rheumatology classification criteria (n=3148) were enrolled between 1992 and 2010 in the multiethnic, cross-sectional Lupus Family Registry and Repository. Clinical, demographic and therapeutic information were extracted from medical records using a standardised form and formalised training. Autoantibodies were assessed by indirect immunofluorescence (antinuclear antibodies (ANA) and antidouble-stranded DNA), precipitin (ENA) and ELISA (IgG and IgM anticardiolipins).
NA patients met SLE classification at a younger age (29.89±12.3 years) than European Americans (EA; 32.02±12.87, P=0.0157) and a similar age to African-Americans (AAs) and Hispanics (HIS). More NA patients had concurrent rheumatic diseases or symptoms, such as Raynaud's phenomenon, interstitial lung disease, Sjӧgren's syndrome and systemic sclerosis. Compared with EAs, NAs were more likely to have high-titre ANA (≥1:3240; P<0.0001) and had more SLE-associated autoantibodies. Autoantibodies with unknown specificities were more common in NAs (41%) compared with other racial/ethnic groups in this collection (AA: 24%, P=0.0006; EA: 17%, P<0.0001; HIS: 23%, P=0.0050). Fewer NA patients used hydroxychloroquine (68%) compared with others (AA: 74%, P=0.0308; EA: 79%, P=0.0001, HIS: 77%, P=0.0173); this was influenced by lower hydroxychloroquine use in NA patients from Latin America (32%). NA patients had higher rates of methotrexate use (28%) compared with AA (18%, P=0.0006) and HIS patients (14%, P=0.0003), higher azathioprine use (38%) compared with EA patients (30%, P=0.0105) and higher mycophenolate mofetil use (26%) compared with EA (17%, P=0.0012) and HIS patients (11%, P<0.0001).
NA patients are diagnosed with SLE earlier in life and present worse concurrent rheumatic disease symptoms than EA patients. NA patients also are more likely to have expanded autoantibody profiles and precipitins of unknown specificities.
系统性红斑狼疮（SLE）是一种发病率和死亡率各异的全身性自身免疫性疾病。我们评估了美国原住民（NA）SLE患者的临床表现、自身抗体特异性及治疗干预措施。
1992年至2010年间，符合1997年美国风湿病学会分类标准的SLE患者（n = 3148）被纳入多民族横断面狼疮家族登记与资料库。使用标准化表格和正规培训从病历中提取临床、人口统计学和治疗信息。通过间接免疫荧光法（抗核抗体（ANA）和抗双链DNA）、沉淀素（ENA）和酶联免疫吸附测定（IgG和IgM抗心磷脂）评估自身抗体。
NA患者比欧洲裔美国人（EA；32.02±12.87岁，P = 0.0157）更年轻（29.89±12.3岁）时达到SLE分类标准，与非裔美国人（AA）和西班牙裔（HIS）年龄相似。更多NA患者并发风湿性疾病或症状，如雷诺现象、间质性肺病、干燥综合征和系统性硬化症。与EA相比，NA更易出现高滴度ANA（≥1:3240；P < 0.0001）且有更多SLE相关自身抗体。与该研究中的其他种族/族裔群体相比，NA中具有未知特异性的自身抗体更常见（41%）（AA：24%，P = 0.0006；EA：17%，P < 0.0001；HIS：23%，P = 0.0050）。与其他患者相比，使用羟氯喹的NA患者较少（68%）（AA：74%，P = 0.0308；EA：79%，P = 0.0001，HIS：77%，P = 0.0173）；这受到拉丁美洲NA患者羟氯喹使用率较低（32%）的影响。与AA患者（18%，P = 0.0006）和HIS患者（14%，P = 0.0003）相比，NA患者甲氨蝶呤使用率更高（28%），与EA患者（30%，P = 0.0105）相比，硫唑嘌呤使用率更高（38%），与EA（17%，P = 0.0012）和HIS患者（11%）相比，霉酚酸酯使用率更高（26%，P < 0.0001）。
NA患者在生命早期被诊断为SLE，且并发风湿性疾病症状比EA患者更严重。NA患者也更可能有扩展的自身抗体谱和未知特异性的沉淀素。
