From the Guidelines
Lupus presents differently in Black women, with a higher prevalence and severity of symptoms, particularly kidney involvement, neurological complications, and discoid lupus, compared to other demographic groups. According to the most recent study 1, patients with SLE, especially those of African/Caribbean descent, should be actively and regularly monitored for kidney involvement, as the clinical presentation can remain silent or asymptomatic for a significant period. The study also highlights the importance of a holistic assessment, including clinical, urinary, and laboratory parameters, and repeated investigations to note the progression of abnormal findings over time.
Some key differences in disease presentation in Black women with lupus include:
- Higher rates of kidney involvement (lupus nephritis) 1
- Increased incidence of neurological complications
- Higher rates of discoid lupus (skin lesions)
- Higher rates of specific laboratory findings, such as low complement levels and anti-Sm and anti-RNP antibodies
Treatment approaches remain similar across populations, including:
- Hydroxychloroquine (200-400mg daily) as a foundation therapy
- Corticosteroids like prednisone for flares
- Immunosuppressants such as mycophenolate mofetil, azathioprine, or belimumab for organ involvement
The differences in disease presentation likely stem from a combination of genetic factors, socioeconomic disparities affecting healthcare access, environmental exposures, and vitamin D deficiency due to darker skin pigmentation 1. Black women with lupus should receive regular screening for kidney disease, cardiovascular complications, and other organ involvement due to their higher risk of these manifestations.
From the Research
Presentation of Lupus in Black Women
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organ systems, and its presentation can vary among different populations 2.
- Studies have shown that Black women with SLE tend to have more severe disease and develop it at an earlier age compared to White women 3, 4.
- The prevalence of certain SLE manifestations, such as renal and neurologic manifestations, is higher in Black women compared to White women 4.
- Black women with SLE are also at increased risk of developing severe manifestations, such as lupus nephritis and thrombocytopenia, compared to White women 4.
Racial Disparities in Lupus Outcomes
- Racial discrimination has been associated with increased disease activity and organ damage in Black women with SLE 5.
- The frequency of self-reported experiences of racial discrimination is correlated with greater SLE activity and organ damage in Black women 5.
- These findings suggest that addressing racial disparities in SLE severity should include policies that address issues of racial discrimination 5.
Treatment and Management of Lupus in Black Women
- Hydroxychloroquine is a standard treatment for SLE and has been associated with a significant reduction in mortality 2.
- Biologic agents, such as belimumab, have been approved for the treatment of SLE and may provide a promising option for refractory lupus 6.
- However, more research is needed to fully understand the efficacy and safety of biologic agents in Black women with SLE 6.