Systemic sclerosis in 3 US ethnic groups: A comparison of clinical, sociodemographic, serologic, and immunogenetic determinants*,**

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Abstract

Objective: To determine whether ethnic factors influence the presentation, serologic expression and immunogenetics of systemic sclerosis (SSc), patients from 3 ethnic groups were compared for clinical features, SSc-associated autoantibodies, and human leukocyte antigen (HLA) class II alleles. Methods: Fifty-four Hispanics, 28 African Americans, and 79 whites from Texas with recent-onset (less than 5 years) SSc enrolled in a prospective longitudinal study were assessed for sociodemographic, clinical, immunologic, immunogenetic, behavioral, and psychologic parameters using validated instruments and standard laboratory techniques. Serologic and immunogenetic characteristics from these patients and larger retrospective SSc cohorts of the same ethnic groups also were examined. Results: Hispanics and African Americans in the prospective cohort were more likely to have diffuse skin involvement, skin pigmentary changes, digital ulcers, pulmonary hypertension (African Americans), and an overall lower sociodemographic status than whites, who had more facial telangiectasia and hypothyroidism. In the larger combined prospective and retrospective groups of SSc patients, whites were likely to have more anticentromere antibodies (ACA) and African Americans more anti-U1-ribonucleoprotein (RNP) and anti-U3-RNP (fibrillarin) autoantibodies. HLA-DQB1*0301 was significantly associated with SSc per se in all 3 ethnic groups; HLA-DRB1*11 correlated with the anti-topoisomerase I antibody response, and HLA-DRB1*01, DRB1*04, and DQB1*0501 with ACA. Conclusions: Important sociodemographic, clinical, and serologic differences exist between whites, African Americans, and Hispanics, despite shared genetic (HLA class II) predisposing factors. The impact of these differences on prognosis remain to be determined. Semin Arthritis Rheum 30:332-346. Copyright © 2001 by W.B. Saunders Company

Section snippets

Patients and methods

The prospective study, called GENISOS, an acronym derived from Genetics versus ENvironment In Scleroderma Outcome Study, was approved by the Institutional Review Board of the participating institutions. It was designed as a collaboration between the University of Texas-Houston Health Science Center (UTH-HSC), the University of Texas Medical Branch at Galveston (UTMB) and the University of Texas-San Antonio Health Science Center (UTSA-HSC). Baseline study visits took place in the clinical

Results

A total of 168 patients were entered into the prospective GENISOS cohort, including 54 Hispanics, 79 whites, 28 African Americans, 6 Asians, and 1 native American (Table 1, Table 4). For the autoantibody and HLA-class II frequency studies, 345 patients meeting ACR criteria for SSc (12) were examined, including the GENISOS patients and an additional 112 white, 23 Hispanic, and 49 African American patients who were consecutively evaluated in the Rheumatology Division at UTH-HSC (Tables 5 and 6).

Discussion

The purpose of this study was to compare clinical, serologic, and immunogenetic features of SSc in the 3 most common ethnic groups in the United States. This was accomplished in 3 ways: 1) by comparing clinical, sociodemographic, and behavioral features in a multiethnic SSc cohort of fairly short disease duration (the GENISOS cohort); 2) by examining autoantibody frequencies of an inclusive cohort of SSc patients meeting ACR criteria for SSc from one geographic location (Texas); and 3) by

Acknowledgements

To Evelyn Johnson and Charles Forbes for their assistance in data entry and database construction. To Rudyard Lanete and Gaston Benavides for their roles as study coordinators. To Kim Jordan and Anthony Thomas for their assistance in the serologic and immunogenetic analyses. To Dr Fred Wigley for his advice and assistance in standardizing the skin scoring among the GENISOS investigators, to Drs Timothy Wright and Robert Winchester and for their helpful comments in the GENISOS study design and

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    *

    Supported by NIH grant Specialized Center of Research (SCOR) in Scleroderma P50AR44888, University Clinic Research Grants M01-RR02558(UTH-HSC), M01-RR00073 (UTMB), M01-RR01346 (UT-SA) and the RGK Foundation (Austin, TX).

    **

    Address reprint requests to John D. Reveille, MD, Division of Rheumatology and Clinical Immunogenetics, The University of Texas Health Science Center at Houston, 6431 Fannin, Houston, TX 77030. E-mail: [email protected]

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