Alarcón GS et al. (2006) Systemic lupus erythematosus in a multiethnic cohort: LUMINA XXXV. Predictive factors of high disease activity over time. Ann Rheum Dis 65: 1168–1174

In 1998, cross-sectional results from LUMINA XXXV (Lupus in Minorities: Nature vs Nurture) showed that ethnicity and genetic factors, as well as socioeconomic, psychological and behavioral variables, were associated with high disease activity in patients with recent-onset systemic lupus erythematosus (SLE). Alarcón and colleagues' follow-up longitudinal study of LUMINA participants investigated these factors in more detail, to establish which factors influence ongoing high disease activity.

The authors evaluated data from 554 LUMINA participants with defined ethnicity (i.e. all four grandparents had identical ethnicity). There were 100 Hispanic patients from Texas, 94 Puerto Rican Hispanic patients, 199 African Americans and 161 Caucasians. At enrollment, patients were aged ≥16 years and had SLE for ≤5 years. High SLE activity (according to American College of Rheumatology criteria) was present in 72% of African Americans, 71.3% of Hispanic patients from Texas, 43.9% of Caucasians, and 31.9% of Puerto Rican Hispanic patients.

Alarcón et al. found that African American and Hispanic (from Texas) ethnicity predicted continued high SLE activity. High SLE activity was also associated with socioeconomic, psychological, and behavioral factors, including lack of health insurance, poor social support, and abnormal, illness-related behaviors. Genetic factors were not associated with continued high SLE activity, despite the association between genetic factors and high SLE activity seen at disease onset in the original LUMINA study. The authors recommend that intervention in the modifiable factors identified might improve outcomes for patients with SLE.