Differences in clinical manifestations and increased severity of systemic lupus erythematosus between two groups of Hispanics: European Caucasians versus Latin American mestizos (data from the RELESSER registry)

Author:

Hernández Cruz B1ORCID,Alonso F2,Calvo Alén J3,Pego-Reigosa J M4,López-Longo F J5,Galindo-Izquierdo M6,Olivé A7,Tomero E8,Horcada L9,Uriarte E10,Erausquin C11,Sánchez-Atrio A12,Montilla C13,Santos Soler G14,Fernández-Nebro A15,Blanco R16,Rodríguez-Gómez M17,Vela P18,Freire M19,Díez-Álvarez E20,Boteanu A L21,Narváez J22,Martínez Taboada V16,Ruiz-Lucea E23,Andreu JL24,Fernández-Berrizbeitia O25,Hernández-Beriain JÁ26,Gantes M27,Pérez-Venegas J J28,Ibáñez-Barceló M29,Pecondón-Español Á30,Marras C31,Bonilla G32,Castellví I33,Moreno M34,Raya E35,Quevedo Vila V E36,Vázquez T37,Ruán J Ibáñez38,Muñoz S39,Rúa-Figueroa Í40ORCID,

Affiliation:

1. Rheumatology Department, Virgen Macarena University Hospital, Seville, Spain

2. Research Unit, Spanish Society of Rheumatology, Madrid, Spain

3. Rheumatology Department, Araba University Hospital, Vitoria, Spain

4. Rheumatology Department, University Hospital Complex, Instituto de Investigación Biomédica de Vigo, Vigo, Spain

5. Rheumatology Department, Gregorio Marañón University Hospital, Madrid, Spain

6. Rheumatology Department, 12th October University Hospital, Madrid, Spain

7. Rheumatology Department, Germans Trías i Pujol University Hospital, Badalona, Spain

8. Rheumatology Department, La Princesa University Hospital, Madrid, Spain

9. Rheumatology Department, Navarra Hospital, Navarra, Spain

10. Rheumatology Department, Donosti Hospital, Guipuzcoa, Spain

11. Rheumatology Department, Dr Negrín University Hospital, Las Palmas de Gran Canaria, Spain

12. Rheumatology Department, Príncipe de Asturias University Hospital, Madrid, Spain

13. Rheumatology Department, Salamanca Clinic University Hospital, Salamanca, Spain

14. Rheumatology Department, Marina Baixa Hospital, Alicante, Spain

15. Rheumatology Department, Carlos Haya University Hospital, Malaga, Spain

16. Rheumatology Department, Marqués de Valdecilla University Hospital, Santander, Spain

17. Rheumatology Department, Hospital Complex of Ourense, Ourense, Spain

18. Rheumatology Department, Alicante General Hospital, Alicante, Spain

19. Rheumatology Department, Juan Canalejo University Hospital, La Coruña, Spain

20. Rheumatology Department, León Hospital, León, Spain

21. Rheumatology Department, Ramon y Cajal University Hospital, Madrid, Spain

22. Rheumatology Department, Bellvitge Hospital, Barcelona, Spain

23. Rheumatology Department, Basurto Hospital, Bilbao, Spain

24. Rheumatology Department, Puerta del Hierro-Majadahonda Hospital, Madrid, Spain

25. Rheumatology Department, Basurto Hospital, Basurto, Spain

26. Rheumatology Department, Hospital Insular of Gran Canaria, Gran Canaria, Spain

27. Rheumatology Department, Tenerife Clinic Hospital, Tenerife, Spain

28. Rheumatology Department, Jerez de la Frontera University Hospital, Cadiz, Spain

29. Rheumatology Department, Son Llatzer Hospital, Mallorca, Spain

30. Rheumatology Department, Miguel Servet University Hospital, Zaragoza, Spain

31. Rheumatology Department, Virgen de la Arrixaca University Hospital, Murcia, Spain

32. Rheumatology Department, La Paz University Hospital, Madrid, Spain

33. Rheumatology Unit, L’Alt Penedés District Hospital, Barcelona, Spain

34. Rheumatology Department, Parc Taulí Hospital, Barcelona, Spain

35. Rheumatology Department, San Cecilio Hospital, Granada, Spain

36. Rheumatology Unit, Monforte Hospital, Lugo, Spain

37. Rheumatology Department, Lucus Augusti Hospital, Lugo, Spain

38. Rheumatology Unit, POVISA Medical Centre, Vigo, Spain

39. Rheumatology Service, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain

40. Rheumatology Department, Doctor Negrín University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain

Abstract

Background Systemic lupus erythematosus (SLE) is regarded as a prototype autoimmune disease because it can serve as a means for studying differences between ethnic minorities and sex. Traditionally, all Hispanics have been bracketed within the same ethnic group, but there are differences between Hispanics from Spain and those from Latin America, not to mention other Spanish-speaking populations. Objectives This study aimed to determine the demographic and clinical characteristics, severity, activity, damage, mortality and co-morbidity of SLE in Hispanics belonging to the two ethnic groups resident in Spain, and to identify any differences. Methods This was an observational, multi-centre, retrospective study. The demographic and clinical variables of patients with SLE from 45 rheumatology units were collected. The study was conducted in accordance with Good Clinical Practice guidelines. Hispanic patients from the registry were divided into two groups: Spaniards or European Caucasians (EC) and Latin American mestizos (LAM). Comparative univariate and multivariate statistical analyses were carried out. Results A total of 3490 SLE patients were included, 90% of whom were female; 3305 (92%) EC and 185 (5%) LAM. LAM patients experienced their first lupus symptoms four years earlier than EC patients and were diagnosed and included in the registry younger, and their SLE was of a shorter duration. The time in months from the first SLE symptoms to diagnosis was longer in EC patients, as were the follow-up periods. LAM patients exhibited higher prevalence rates of myositis, haemolytic anaemia and nephritis, but there were no differences in histological type or serositis. Anti-Sm, anti-Ro and anti-RNP antibodies were more frequently found in LAM patients. LAM patients also had higher levels of disease activity, severity and hospital admissions. However, there were no differences in damage index, mortality or co-morbidity index. In the multivariate analysis, after adjusting for confounders, in several models the odds ratio (95% confidence interval) for a Katz severity index >3 in LAM patients was 1.45 (1.038–2.026; p = 0.02). This difference did not extend to activity levels (i.e. SLEDAI >3; 0.98 (0.30–1.66)). Conclusion SLE in Hispanic EC patients showed clinical differences compared to Hispanic LAM patients. The latter more frequently suffered nephritis and higher severity indices. This study shows that where lupus is concerned, not all Hispanics are equal.

Funder

Sociedad Española de Reumatologia

Publisher

SAGE Publications

Subject

Rheumatology

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