title: Comparison of ethnicity, gender, age of onset and outcome in South Africans with systemic lupus erythematosus.
abstract: Ethnicity, gender and age of onset are reported to influence the expression and outcome of systemic lupus erythematosus. We studied a multi-ethnic cohort of 408 South Africans (91.2% females) comprising 237 (58.1%) Indians, 137 (33.6%) African Blacks, 17 (4.2%) Mixed ethnicity and 17 (4.2%) Whites. The most common manifestations were arthritis (80.6%), photosensitivity (67.2%), oral ulcers (50.0%), malar rash (49.0%) and renal (39.2%). The common laboratory findings were positive anti-nuclear factor (96.8%), haematological (74.8%) and anti-dsDNA antibodies (45.3%). Serositis ( p = 0.002), nephritis ( p = 0.039), leucopaenia ( p = 0.001), haemolytic anaemia ( p = 0.026), anti-dsDNA antibodies ( p = 0.028) and anti-Sm antibodies ( p = 0.050) were more common in African Blacks compared to Indians. Males had increased prevalence of discoid rash ( p = 0.006) and anti-Sm antibodies ( p = 0.016). Discoid rash ( p = 0.018), renal involvement ( p < 0.001), psychosis ( p = 0.028), seizures ( p = 0.020), anti-dsDNA antibodies ( p = 0.009), leucopaenia ( p = 0.006), haemolytic anaemia ( p = 0.017) and thrombocytopaenia ( p = 0.023) were more common with early-onset systemic lupus erythematosus. On multivariate analysis, the independent predictors of death were renal involvement, anti-dsDNA antibodies and seizures. There were 53 (13%) deaths and the five- and 10-year survival was 90.8% and 85.7% respectively, with no differences related to ethnicity or age of onset. In conclusion, we report on the spectrum and outcome of systemic lupus erythematosus in a large South African multi-ethnic cohort.
authors.affiliation: 1 Department of Rheumatology, Inkosi Albert Luthuli Central Hospital and School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: A
authors.initials: A
authors.lastname: Budhoo
authors.affiliation: 1 Department of Rheumatology, Inkosi Albert Luthuli Central Hospital and School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: G M
authors.initials: GM
authors.lastname: Mody
authors.affiliation: 1 Department of Rheumatology, Inkosi Albert Luthuli Central Hospital and School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.|2 Current address: Department of Medicine, Walter Sisulu University, Mthatha, South Africa.
authors.forename: T
authors.initials: T
authors.lastname: Dubula
authors.affiliation: 1 Department of Rheumatology, Inkosi Albert Luthuli Central Hospital and School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: N
authors.initials: N
authors.lastname: Patel
authors.affiliation: 3 Department of Nephrology, Inkosi Albert Luthuli Central Hospital, and School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: P G
authors.initials: PG
authors.lastname: Mody
mesh_terms: D000328:Adult; D017668:Age of Onset; D044466:Asian People / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012727:Sex Characteristics; D013019:South Africa / Q000453:epidemiology; D016019:Survival Analysis; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: African Blacks; Indians; Systemic lupus erythematosus; deaths; early-onset SLE; ethnicity; gender; late-onset SLE; outcome; survival