title: The effect of ethnicity and genetic ancestry on the epidemiology, clinical features and outcome of systemic lupus erythematosus.
abstract: In this in-depth review, we examine the worldwide epidemiology of SLE and summarize current knowledge on the influence of race/ethnicity on clinical manifestations, disease activity, damage accumulation and outcome in SLE. Susceptibility to SLE has a strong genetic component, and trans-ancestral genetic studies have revealed a substantial commonality of shared genetic risk variants across different genetic ancestries that predispose to the development of SLE. The highest increased risk of developing SLE is observed in black individuals (incidence 5- to 9-fold increased, prevalence 2- to 3-fold increased), with an increased risk also observed in South Asians, East Asians and other non-white groups, compared with white individuals. Black, East Asian, South Asian and Hispanic individuals with SLE tend to develop more severe disease with a greater number of manifestations and accumulate damage from lupus more rapidly. Increased genetic risk burden in these populations, associated with increased autoantibody reactivity in non-white individuals with SLE, may explain the more severe lupus phenotype. Even after taking into account socio-economic factors, race/ethnicity remains a key determinant of poor outcome, such as end-stage renal failure and mortality, in SLE. Community measures to expedite diagnosis through increased awareness in at-risk racial/ethnic populations and ethnically personalized treatment algorithms may help in future to improve long-term outcomes in SLE.
authors.affiliation: Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Myles J
authors.initials: MJ
authors.lastname: Lewis
authors.affiliation: Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Jawad
mesh_terms: D044466:Asian People / Q000235:genetics / Q000706:statistics & numerical data; D044383:Black People / Q000235:genetics / Q000706:statistics & numerical data; D005006:Ethnicity / Q000235:genetics / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000235:genetics / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000209:etiology / Q000235:genetics; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000208:ethnology* / Q000235:genetics / Q000503:physiopathology; D008181:Lupus Nephritis / Q000208:ethnology* / Q000235:genetics; D015995:Prevalence; D012959:Socioeconomic Factors; D044465:White People / Q000235:genetics / Q000706:statistics & numerical data
keywords: ancestry; autoantibodies; epidemiology; ethnic groups; ethnicity; genetics; incidence; lupus nephritis; prevalence; systemic lupus erythematosus