Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Do Race/Ethnicity and Geography Affect Outcomes in An Inception Cohort of Patients with Systemic Lupus Erythematosus Followed for at Least 5 Years?

Gladman1,  D. D., Urowitz1,  Murray B., Ibanez1,  Dominique, Anderson1,  Nicole, Systemic Lupus International Collaborating Clinics (SLICC),  

Toronto Western Hospital and University of Toronto, Toronto, ON


We have previously demonstrated that there are differences in the features of SLE at inception when studied by geographic and race/ethnicity origins. In this study we examined the influences of ethnicity and geography on outcomes in patients followed for at least 5 years.


An international research network comprising 27 centres from 11 countries has followed an inception cohort of SLE patients yearly according to a standardized protocol between 2000 and 2011. Of these, 537 patients followed for a minimum of 5 years constitute the study population. Disease activity was measured by SLEDAI-2K and Adjusted Mean SLEDAI-2K (AMS) at 5 years, damage using the SLICC/ACR Damage Index (SDI). Multivariate proportional hazards model were evaluated adjusting for age, sex, SLEDAI-2K, and use of medications at enrolment. AMS was analysed by linear regression.


Of the 537 patients there were 469 (87.3%) females. At enrolment the mean age was 35.3 ± 14.1 years, SLEDAI-2K was 5.7 ± 5.6 and disease duration 0.5 ± 0.3 years. 70% were on glucocorticosteroids, 63% on antimalarials, and 38% on immunosuppressive medications. The average length of follow up was 7.2 ± 1.5 years. At 5 years, mean AMS was 3.8 ± 3.2, and SDI scores >= 1 were found in 240 patients, while the SDI was >= 3 in 87 patients.

SiteNAMS-5SDI >= 1SDI >= 3   
  MeanPHR95% CIHR95% CI
Asia522.520.080.370.20, 0.690.540.18, 1.65
Canada1463.29 1.00 1.00 
Europe1503.030.400.810.57, 1.150.970.52, 1.82
Mexico784., 1.771.880.93, 3.79
USA1112.950.311.140.79, 1.651.871.02, 3.45
Asian783.300.690.580.36, 0.930.680.30, 1.52
African decent813.640.151.330.93, 1.901.660.93, 2.97
Caucasian2773.16 1.00 1.00 
Hispanic854.310.0011.410.96, 2.071.600.85, 3.00


At 5 years of follow up the AMS is higher in Hispanics by ethnicity and in Mexicans by country. Presence of any damage is lowest among Asians and in Asia. High levelsof damage accrual is associated with country (USA) but not necessarily with race/ethnicity.

To cite this abstract, please use the following information:
Gladman, D. D., Urowitz, Murray B., Ibanez, Dominique, Anderson, Nicole, Systemic Lupus International Collaborating Clinics (SLICC), ; Do Race/Ethnicity and Geography Affect Outcomes in An Inception Cohort of Patients with Systemic Lupus Erythematosus Followed for at Least 5 Years? [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1395

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