scholarly journals Racial Discrimination, Disease Activity, and Organ Damage: The Black Women’s Experiences Living With Lupus (BeWELL) Study

2019 ◽  
Author(s):  
David H Chae ◽  
Connor D Martz ◽  
Thomas E Fuller-Rowell ◽  
Erica C Spears ◽  
Tianqi Tenchi Gao Smith ◽  
...  
Keyword(s):  
Black Women ◽  
Confidence Interval ◽  
Racial Discrimination ◽  
Lupus Erythematosus ◽  
Organ Damage ◽  
Rapid Progression ◽  
Systemic Lupus ◽  
Women’S Experiences ◽  
Women's Experiences ◽  
Activity Questionnaire

Abstract Black women are disproportionately affected by systemic lupus erythematosus (SLE), a chronic, potentially debilitating autoimmune disease, and they also experience more rapid progression and worse outcomes compared with other groups. We examined if racial discrimination is associated with disease outcomes among 427 black women with a validated diagnosis of SLE, who live in the Atlanta, Georgia, metropolitan area, and were recruited to the Black Women’s Experiences Living with Lupus Study (2015–2017). Frequency of self-reported experiences of racial discrimination in domains such as employment, housing, and medical settings was assessed using the Experiences of Discrimination measure. SLE activity in the previous 3 months, including symptoms of fatigue, fever, skin rashes, and ulcers, was measured using the Systemic Lupus Activity Questionnaire; irreversible damage to an organ or system was measured using the Brief Index of Lupus Damage. Results of multivariable linear regression analyses examining the Systemic Lupus Activity Questionnaire and log-transformed Brief Index of Lupus Damage scores indicated that increasing frequency of racial discrimination was associated with greater SLE activity (b = 2.00, 95% confidence interval: 1.32, 2.68) and organ damage (b = 0.08, 95% confidence interval: 0.02, 0.13). Comprehensive efforts to address disparities in SLE severity should include policies that address issues of racial discrimination.

Obesity increases the incidence of new-onset lupus nephritis and organ damage during follow-up in patients with systemic lupus erythematosus

Lupus ◽  
2020 ◽  
Vol 29 (6) ◽  
pp. 578-586 ◽  
Author(s):  
Ji-Hyoun Kang ◽  
Haimuzi Xu ◽  
Sung-Eun Choi ◽  
Dong-Jin Park ◽  
Jung-Kil Lee ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Confidence Interval ◽  
Lupus Erythematosus ◽  
Odds Ratio ◽  
Global Assessment ◽  
Clinical Manifestations ◽  
Organ Damage ◽  
Physician Global Assessment ◽  
Systemic Lupus

Objective This study explored the effects of obesity on clinical manifestations, disease activity and organ damage in Korean patients with systemic lupus erythematosus (SLE). Methods We assessed 393 SLE patients annually for three consecutive years based on demographic information, clinical manifestations, laboratory findings and Physician Global Assessment, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2000 and Systemic Lupus International Collaborating Clinics (SLICC) damage index (SDI) scores. Patients were grouped by body mass index (BMI): normal weight, BMI <23 kg/m2; overweight, 23 kg/m2 ≤BMI <25 kg/m2; obese, BMI ≥25 kg/m2. The impact of obesity on clinical outcomes was assessed using univariate and multivariate analyses. Results Of the 393 patients, 59 (15.0%) were obese at enrollment. They had more comorbidities compared with non-obese patients, including diabetes, hypertension, hyperlipidemia and pulmonary hypertension. Nephritis at enrollment and newly developed nephritis during follow-up were more common ( p = 0.002 and p = 0.002, respectively) and Physician Global Assessment and SDI scores were higher in these patients for three consecutive years ( p = 0.017 and p = 0.039, respectively). Multivariate analysis revealed that obesity was significantly associated with development of nephritis during follow-up (odds ratio = 26.636; 95% confidence interval, 11.370–62.399; p < 0.001) and cumulative organ damage (odds ratio = 4.096; 95% confidence interval, 2.125–7.894, p < 0.001). Conclusions The incidences of newly developed nephritis and cumulative organ damage were higher in obese SLE patients than in non-obese SLE patients.

scholarly journals Vicarious Racism Stress and Disease Activity: The Black Women’s Experiences Living with Lupus (BeWELL) Study

2018 ◽  
Author(s):  
Connor Martz
Keyword(s):  
African American ◽  
Disease Activity ◽  
Racial Disparities ◽  
African American Women ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
American Women ◽  
Women’S Experiences ◽  
Women's Experiences ◽  
Health Related

Background: Indirect or vicarious exposure to racism (e.g., hearing about or observing acts of racism or discrimination) is a salient source of stress for African Americans. Emerging research suggests that these “secondhand” experiences of racism may contribute to racial health inequities through stress-mediated pathways. Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disease that disproportionately impacts African American women and is characterized by racial disparities in severity. Health outcomes in this population may be susceptible to vicarious racism given that SLE is shown to be sensitive to psychosocial stress. Methods: Data are from 431 African American women with SLE living in Atlanta, Georgia in the Black Women’s Experiences Living with Lupus (BeWELL) Study (2015-2017). Vicarious racism stress was measured with four items assessing distress from: (1) hearing about racism in the news; (2) experiences of racism among friends or family; (3) witnessing racism in public; and (4) racism depicted in movies and television shows. Multivariable linear regression was used to examine associations with disease activity measured using the Systemic Lupus Activity Questionnaire. Results: Adjusting for sociodemographic and health-related covariates, vicarious racism stress was associated with greater disease activity (b=2.15; 95% CI=1.04-3.27). This association persisted even after adjustment for personal experiences of racial discrimination (b=1.80; 95% CI=0.67-2.92). Conclusions: Vicarious racism may result in heightened disease activity and contribute to racial disparities in SLE. Our findings suggest that acts of racism committed against members of one’s racial group may have distinct health consequences beyond the immediate victim or target.

scholarly journals POS0173 METABOLOMIC PROFILING AND SYMPTOM BURDEN IN BLACK WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 299-300
Author(s):  
L. P. Kimble ◽  
A. Khosroshahi ◽  
R. C. Eldridge ◽  
G. S. Brewster ◽  
N. S. Carlson ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Black Women ◽  
Lupus Erythematosus ◽  
Energy Production ◽  
Symptom Burden ◽  
Black Female ◽  
Multiple Chronic Conditions ◽  
Systemic Lupus ◽  
Metabolomics Data ◽  
Metabolomics Analysis

Background:Black individuals with systemic lupus erythematosus (SLE), who are predominantly women, have disproportionately poorer health outcomes across the trajectory of their disease including increased mortality, higher symptom burden, and poor quality of life than non-Hispanic Whites. The heterogeneity of immunopathology and biochemical complexity of SLE create major knowledge gaps around the mechanisms of disease and differences in SLE symptom expression. Metabolomics may reveal biochemical dysregulation that underlies SLE symptoms and provide novel metabolic targets for precision symptom interventions.Objectives:We conducted untargeted metabolomic plasma profiling of Black females with SLE and Black female non-SLE controls to gain insight into metabolic disturbances associated with SLE.Methods:We analyzed blood specimens collected from 23 Black female patients with diagnosis of SLE during a routine outpatient rheumatology visit and from 21 Black female non-SLE controls whose data were collected as part of another study of obese caregivers. Data collection for both cases and controls was completed with harmonized protocols. Clinical data for cases were obtained via chart review and both cases and controls completed identical, reliable and valid measures of fatigue, depression, anxiety, and sleep disturbance. A commercial metabolomics analysis company within the US conducted untargeted metabolomics on the 44 plasma samples using ultrahigh performance liquid chromatography/tandem mass spectrometry along with metabolite identification and quantification to examine differences between SLE/non-SLE groups.Results:All SLE subjects met 2019 EULAR/ACR criteria (Aringer et al., 2019). SLE subjects were significantly (p < .05) younger (42.5 ± 12.2 vs. 63.2 ± 6.4), had a lower BMI (30.3 ± 9.4 vs. 34.9 ± 4.1), and greater co-morbidities (2.3 ± 1.3 vs. 1.1 ± 1.3) than non-SLE controls. SLE subjects reported higher symptoms than controls across all measures, but differences were not statistically significant. Metabolomics analysis revealed 290 biochemicals that were statistically significant (p ≤ .05) between SLE and non-SLE groups. Random Forest analysis had a predictive accuracy of 91% in differing between the two groups using out-of-bag sampling. Significant metabolic differences between groups were noted in biochemicals associated with glycolysis, the TCA cycle (see Table 1), fatty acid metabolism, branched chain amino acids, sterol levels, heme catabolism, and potential markers of renal impairment. Overall, the differences would suggest reduced energy production among SLE patients compared to controls.Conclusion:Black women with SLE had biochemical profiles consistent with reduced energy production which has implications for the high burden of fatigue and other symptoms in this population. Future work with larger sample sizes should involve integrating symptom and metabolomics data to identify potential biomarkers of symptom burden.References:Aringer, M., Costenbader, K., Daikh, D. et al. (2019). 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis, 78,1151-1159.Acknowledgements:This work was supported by a research re-entry supplement to L. Kimble under the parent award 1P30NR018090-02S1 Center for the Study of Symptom Science, Metabolomics, and Multiple Chronic Conditions (Song, PI) funded by the National Institute of Nursing Research, National Institutes of Health, USA.Disclosure of Interests:Laura P. Kimble: None declared, Arezou Khosroshahi Consultant of: Have received honorarium for advisory board but has no relationship with this work., Grant/research support from: Have received a research grant from Pfizer; but has no relationship with this work., Ronald C. Eldridge: None declared, Glenna S. Brewster: None declared, Nicole S. Carlson: None declared, Elizabeth J. Corwin: None declared

Usefulness of cardiac screening in patients with systemic lupus erythematosus and anti-Ro/SSA antibodies

Lupus ◽  
2021 ◽  
pp. 096120332110279
Author(s):  
Roger Villuendas ◽  
Melania Martínez-Morillo ◽  
Gladys Juncà ◽  
Aina Teniente-Serra ◽  
Carles Diez ◽  
...  
Keyword(s):  
Heart Rate ◽  
Lupus Erythematosus ◽  
Holter Monitoring ◽  
Organ Damage ◽  
Cardiac Conduction ◽  
Systemic Lupus ◽  
Cardiac Screening ◽  
Cardiac Evaluation ◽  
Registration Number ◽  
Clinically Significant

Objectives Recent data suggest that some adult patients with autoimmune rheumatic diseases may develop cardiac conduction and repolarization abnormalities mediated by anti-Ro/SSA antibodies. We aim to investigate the utility of a cardiac screening in patients with systemic lupus erythematous (SLE) and anti-Ro/SSA positivity. Methods SLE patients who consecutively attended a Rheumatology clinic during 1 year where evaluated for the presence and levels of anti-Ro/SSA antibodies, and clinical and biological markers of organ damage and disease activity. All participants underwent a cardiovascular anamnesis and physical examination, ECG, echocardiography, and 24-hour Holter. Results Of the 145 recruited patients, 49 (32%) had anti-Ro/SSA positivity. None had any degree of atrioventricular block in the ECG or Holter monitoring. No significant differences were observed between anti-Ro/SSA–positive vs. negative patients in terms of PR, QRS or QTc intervals. No clinically significant arrhythmias were recorded during Holter monitoring and no differences in average heart rate, heart rate variability, or atrial or ventricular ectopy burden were observed. Finally, no differences were found in echocardiographic measurements. Conclusions In this study of SLE patients, anti-Ro/SSA positivity was not associated with significant alterations in ECG, echocardiography, or 24-hour Holter. These findings do not support ordinary cardiac evaluation in these patients. ( Clinicaltrials.gov registration number: NCT02162992).

scholarly journals POS0774 INFLUENZA INFECTION AS A TRIGGER FOR SYSTEMIC LUPUS ERYTHEMATOSUS FLARES RESULTING IN HOSPITALIZATION

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 641.1-641
Author(s):  
Y. B. Joo ◽  
Y. J. Park
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Confidence Interval ◽  
Lupus Erythematosus ◽  
Influenza Infection ◽  
Age Groups ◽  
Case Series ◽  
Incidence Rates ◽  
Systemic Lupus ◽  
Control Interval ◽  
The Impact

Background:Infections have been associated with a higher risk of systemic lupus erythematosus (SLE) flares, but the impact of influenza infection on SLE flares has not been evaluated.Objectives:We evaluated the association between influenza infection and SLE flares resulting in hospitalization.Methods:SLE flares resulting in hospitalization and influenza cases were ascertained from the Korean national healthcare insurance database (2014-2018). We used a self-controlled case series design. We defined the risk interval as the first 7 days after the influenza index date and the control interval was defined as all other times during the observation period of each year. We estimated the incidence rates of SLE flares resulting in hospitalization during the risk interval and control interval and compared them using a Poisson regression model.Results:We identified 1,624 influenza infections among the 1,455 patients with SLE. Among those, there were 98 flares in 79 patients with SLE. The incidence ratio (IR) for flares during the risk interval as compared with the control interval was 25.75 (95% confidence interval 17.63 – 37.59). This significantly increased the IRs for flares during the risk interval in both women (IR 27.65) and men (IR 15.30), all age groups (IR 17.00 – 37.84), with and without immunosuppressive agent (IR 24.29 and 28.45, respectively), and with and without prior respiratory diseases (IR 21.86 and 26.82, respectively).Conclusion:We found significant association between influenza infection and SLE flares resulting in hospitalization. Influenza infection has to be considered as a risk factor for flares in all SLE patients regardless of age, sex, medications, and comorbidities.References:[1]Kwong, J. C. et al. Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection. N Engl J Med 2018:378;345-353.Table 1.Incidence ratios for SLE flares resulting in hospitalization after influenza infectionRisk intervalIncidence ratio95% CIDuring risk interval for 7 days / control interval25.7517.63 – 37.59Days 1-3 / control interval21.8114.71 – 32.35Days 4-7 / control interval7.563.69 – 15.47SLE, systemic lupus erythematosus; CI, confidence intervalDisclosure of Interests:None declared

scholarly journals SAT0232 PERCEPTION OF THE DISEASE IN PATIENTS WITH EARLY SYSTEMIC LUPUS ERYTHEMATOSUS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1059.3-1059
Author(s):  
M. Garabajiu ◽  
L. Mazur-Nicorici ◽  
T. Rotaru ◽  
V. Salaru ◽  
S. B. Victoria ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Disease Duration ◽  
Activity Index ◽  
Damage Index ◽  
Organ Damage ◽  
Systemic Lupus

Background:Systemic lupus erythematosus is an autoimmune disease with a major impact on patient’s quality of life.Objectives:To evaluate patient’s attitude toward early disease and factors that influence it.Methods:Performed case-control study included SLE patients that fulfilled SLICC, 2012 classification criteria. The research included two groups of patients: early SLE – 1stgroup (disease duration ≤24 months) and non-early SLE – 2ndgroup control (disease duration >24 months). The pattern of the disease activity was assessed by patient global assessment (PGA), Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and Systemic Lupus Activity Measure (SLAM), for SLE activity, SLICC/ACR Damage Index (DI) for disease irreversible changes and SF-8 for the Quality of Life (QoL).Results:A total of 101 SLE patients with 34 in the 1stgroup (early SLE) and 67 in the 2ndgroup (non-early SLE) was analyzed. The disease activity showed high disease activity in both groups by SLEDAI (7,02±4,16 and 6,26±4,43 points, p>0,05) and SLAM (7,47±4,40 and 7,31±4,10 points, p>0,05) such as (46,97±19,39 vs 47,98±22,41 points). The QoL was appreciated as low, by both components (mental and physical), in groups. The damage index was higher in the 2nd group (0,23±0,43 and 1,07±1,29, p<0,001), which can be explained by the development of irreversible changes with the increase of disease duration.The PGA in early SLE was influenced by subjective symptoms contained in SLAM index (r=0,48, p<0,05), such as fatigue and depression, and the level of the quality of life (r=0,65, p<0,001). Meantime, PGA in patients with longer disease duration (>2 years), was influenced by the presence of organ damage by SLICC/ACR DI (0,23, p<0,05) and objective findings of the disease activity contained in SLEDAI (r=0,33, p<0,005) and SLAM (0,44, p<0,001).Conclusion:The disease recognition in patients with early SLE was determined by subjective and psycho-emotional signs, while in patients with longer disease duration it was influenced by organ damage and complications.References:no referencesDisclosure of Interests:None declared

FRI0168 ASSOCIATION OF OVERWEIGHT/OBESITY WITH IMPAIRED HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 668-669
Author(s):  
A. Gomez ◽  
F. H. Butrus ◽  
P. Johansson ◽  
E. Åkerström ◽  
S. Soukka ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Linear Regression Analysis ◽  
Organ Damage ◽  
Health Related Quality ◽  
Systemic Lupus ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related ◽  
Impaired Health

Background:Patients with systemic lupus erythematosus (SLE) experience a considerably impaired health-related quality of life (HRQoL) compared with the general population. Previous literature has implied an association between high body mass index (BMI) and HRQoL diminutions. However, data are scarce and further exploration in large study populations and, importantly, with regard to the clinical significance of this association is needed.Objectives:The aim of this study was to determine whether overweight and/or obesity were associated with impaired physical and/or mental HRQoL aspects in the SLE population of two large clinical trials.Methods:We utilised pooled baseline data from the BLISS-52 (NCT00424476) and BLISS-76 (NCT00410384) clinical trials of belimumab (N=1684). Access to data was granted by GlaxoSmithKline. The patients were stratified into four groups based on their body mass index (BMI), according to WHO guidelines. We conducted comparisons between non-overweight versus overweight, and non-obese versus obese SLE patients. HRQoL was self-reported using the Medical Outcomes Study (MOS) short form 36 (SF-36) health survey, the functional assessment of chronic illness therapy (FACIT)-Fatigue scale and the three-level EuroQol- 5 Dimension (EQ-5D) questionnaire. We explored whether the differences in scores were clinically meaningful using previously determined thresholds for minimal clinically important differences (MCIDs). The non-parametric Mann-Whitney U test was used for comparisons between different BMI groups. Linear regression analysis was next applied to test independence in multivariable models, adjusting for age, sex, ethnicity, disease duration, disease activity, organ damage and standard of care treatment.Results:Forty-four per cent (44%) of the patients had a BMI score over the normal range, and 18% were obese. The overweight group performed worse than the non-overweight with regard to FACIT-Fatigue scores (mean ± standard deviation: 27.7 ± 12.1 vs 32.0 ± 11.3; P<0.001), EQ-5D score (0.70 ± 0.19 vs 0.76 ± 0.18; P<0.001) and all SF-36 subscales and component summaries. The differences were greater than the MCIDs for physical component summary (PCS) scores (36.9 ± 9.3 vs 40.8 ± 9.6; P<0.001), physical functioning (53.3 ± 25.1 vs 63.6 ± 25-1; P<0.001), role physical (48.0 ± 27.1 vs 55.6 ± 26.9; P<0.001), bodily pain (43.8 ± 22.4 vs 52.5 ± 25.1; P<0.001), vitality (39.6 ± 21.7 vs 46.6 ± 21.3; P<0.001), and social functioning scores (55.8 ± 25.2 vs 62.6 ± 25.2; P<0.001). Likewise, obese patients reported worse FACIT-Fatigue scores (25.7 ± 11.9 vs 31.1 ± 11.6; P<0.001), EQ-5D scores (0.68 ± 0.20 vs 0.75 ± 0.18; P<0.001) and clinically important diminutions of HRQoL in all SF-36 items, except for the mental component summary (MCS), role emotional and mental health.In multivariable linear regression analysis, the overweight and obese group showed worse PCS scores (standardised coefficient: β=-0.09; P<0.001 and β=-0.13; P<0.001, respectively) and FACIT-Fatigue scores (β=-0.11; P<0.001 and β=-0.10; P<0.001, respectively), and overweight patients had significantly impaired MCS scores (β=-0.05; P=0.039), irrespective of other factors. High disease activity and organ damage were associated with impaired HRQoL in all aspects, while Asian patients reported better PCS scores (and β=0.29; P=0.007) and FACIT-Fatigue scores (β=0.33; P=0.002).Conclusion:BMI above normal was highly associated with HRQoL impairment, especially in physical aspects. Further survey to examine causality is warranted to support structured weight control strategies as an intervention towards a more favourable HRQoL.Disclosure of Interests:None declared

scholarly journals Ebuhlanti Amandla ngawethu: Womanism and black theology of liberation, in memory of Vuyani Shadrack Vellem

2020 ◽  
Vol 76 (3) ◽  
Author(s):  
Fundiswa A. Kobo
Keyword(s):  
Black Women ◽  
Lived Experiences ◽  
Black Theology ◽  
Black Consciousness ◽  
The West ◽  
Women’S Experiences ◽  
Women's Experiences ◽  
Heuristic Device ◽  
A Site ◽  
Theology Of Liberation

The liberation of black humanity has been an area of scholarly reflection by black theologians and the black consciousness communities. The constructs of oppression such as race, class and sexism amongst others have been critiqued in the quest for liberation of a fragmented black humanity. In this article, this quest for liberation happens within ubuhlanti [kraal], a site for which Vuyani Vellem is ‘like a hermeneutical circle, where the mediations of the bonds of spheres and the instantiation of their life take place’. By looking at a fragmented black humanity and black women’s experiences, we posit that no western framework could ever be representative of those bodies, ubuhlanti becomes our solution as a heuristic device and symbol of a communication of the efficacy of integrated life. From a womanist perspective, ubuhlanti decentres the West. Ebuhlanti Amandla ngawethu [power belongs to us], as black women and men dialogue issues that affect black humanity. The whole proposition of this dialogue ebuhlanti is animated by our lived experiences, which already offer alternatives for us to decentre.Contribution: Premised by the lived experiences of black humanity in their quest for liberation, this paper contributes in the dewesternising discourse by presenting alternative epistemologies and spiritualities. A womanist dialogue with black theology of liberation ebuhlanti, a decolonising and decentring praxis for the liberation of black humanity is our solution as blacks.

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