Racial Disparities Result in Unprecedented Differences in Outcomes for SLE Patients

Although the advent of the MMF era has brought forth important gains for black patients in particular, many questions remain unanswered. Will advances in our understanding of genetics lead to the identification of new genetic contributors to severe lupus? Recent studies suggest that alleles of APOL1 that are commonly found in individuals of African heritage may be strong predictors of ESRD from lupus nephritis.¹² Similarly, early evidence suggests that there may be a genetic contribution to the rates of MMF metabolism that may predispose black patients to a lack of response to MMF therapy. Can we glean new knowledge about the role of socioeconomic and environmental factors that contribute to worsening lupus?

These differences may now be more apparent, given our greater understanding of the racial differences in response to therapy. The issues of access and adherence to therapy strategies remain poorly addressed topics. Can we improve access to, and delivery of, care by adapting strategies developed in the fight against HIV for lupus patients?

As we enter the era of personalized medicine, we will ultimately have to develop approaches that account for the various genetic, social and environmental factors and are tailored to the needs of the individual patient.

Eric L. Wise, MD, is a rheumatologist in Ann Arbor, Mich.

W. Joseph McCune, MD, is a rheumatologist at the University of Michigan, in Ann Arbor, Mich., and was recognized as a Master by the ACR in 2014.

References

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