BIRMINGHAM, Ala—Targeted interventions aimed at modifiable risk factors that predict high levels of systemic lupus erythematosus (SLE) disease activity may help alter the course of the disease, according to new data from the Lupus in Minorities: Nature Versus Nurture (LUMINA) cohort that will appear in the September issue of the Annals of the Rheumatic Diseases.¹ High on the list of possible treatment targets are poor coping styles and lack of social support.

The researchers found that patients who were Hispanic and residing in Texas or were African American and lacked health insurance, displayed high levels of helplessness, had abnormal illness-related behaviors, or had poor social support were likely to have high levels of lupus disease activity. African admixture and anti–double-stranded DNA antibodies also predicted high levels of disease activity, and age was negatively associated with disease activity. Genetic factors were not associated with disease activity, the study showed.

"Given that high disease activity predicts higher levels of disease activity at subsequent visits, and that disease activity predicts damage accrual, it is important to aggressively control disease activity," according to lead researcher Graciela Alarcón, MD, MPH, the Jane Knight Lowe Chair of Medicine in Rheumatology at the University of Alabama at Birmingham. "Some socioeconomic factors—ethnicity—are not amenable to intervention or can only be changed at the societal level—poverty, lack of health insurance—yet poor coping styles and poor social support can be modified at the individual level and managed in parallel with treating the disease properly."

The LUMINA Cohort comprised 554 subjects, including 100 Hispanic patients from Texas, 94 Hispanic patients from Puerto Rico, 199 African Americans, and 161 white men and women. In total, the group made 2366 doctor's visits; 47% of the patients and 29% of the visits were characterized by high levels of disease activity as assessed by the Systemic Lupus Activity Measure-Revised (SLAM-R) >10. Follow-up spanned from 0 to 11 years, with a median of 3.5 years.

Results Highlight Access Problems

The article shows "what a huge problem [lack of health insurance, helplessness, abnormal illness-related behaviors, and poor social support] is and that it has a terrible impact on the burden of illness, but the way the healthcare system is set up, unless you have good insurance, you don't have access to [such] help," Joan T. Merrill, MD, head of the Clinical Pharmacology Research Program at the Oklahoma Medical Research Foundation in Oklahoma City and medical director of the Lupus Foundation of America, told CIAOMed.

"This only brings to light how important taking care of the whole patient is and that there is a crisis with underinsured and uninsured patients," she said. "There is a greater shortage of support from social workers, psychologists, and nurses trained to help people with healthcare and coping skills at home for the underinsured and uninsured and this study is suggesting that this may have a tremendous impact on lupus patients."

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Reference

1. Alarcón GS, Calvo-Alèn J, McGwin Hr G, et al. Systemic lupus erythematosus in a multiethnic cohort: LUMINA XXXV. Predictive factors of high disease activity over time. Ann Rheum Dis. 2006;65:1168-1174.