A population-based study of the autoimmune disease lupus in Black patients shows that the risk of cardiovascular disease is strikingly high in young patients –19 times higher than in non-Blacks in the first 12 years after diagnosis – and may be predicted by a characteristic rash.
The study, published in the Journal of Rheumatology, is also important because while lupus risk is two to three times higher in the Black population, most earlier research was done on white populations. While lupus, which is also known as systemic lupus erythematosus, can affect anyone, Black women with lupus are more than three times more likely to develop kidney failure and die due to lupus, according to Dr. Shivani Garg, rheumatologist, UW Health, assistant professor of medicine, rheumatology, University of Wisconsin School of Medicine and Public Health.
“Our study shows that the risk of cardiovascular disease (CVD) starts early after diagnosis and is strikingly high in Black people with lupus and those who present with renal disease and discoid rash (a chronic skin presentation of lupus),’’ Garg said.
Garg, who is also lead author of the study and director of the UW Health Lupus and Lupus Nephritis Clinic, and co-authors analyzed data from 336 lupus patients enrolled in the Georgia Lupus Registry, a unique population-based cohort of predominantly Black people living in the metropolitan area of Atlanta, Georgia.
They found two timepoints when the risk of CVD rose markedly for patients, one was two years after the first diagnosis, and one was 11 years later. These findings change the thinking among those caring for patients with the disease, because CVD problems had generally been thought to develop later in the course of lupus, according to Garg.
The study is also the first to associate this chronic discoid rash – which occurs on the face and head but can affect other areas as well – with CVD. The rash’s name refers to its appearance of small, raised coin-shaped discs. The researchers found that those with the rash have a much higher risk of developing CVD, regardless of race. It is one of several rashes associated with different types of lupus, according to Garg.
Garg said that this study highlights at-risk populations and disease presentations that increase CVD risk. These symptoms should prompt more aggressive screening and management of CVD risk factors in such groups to reduce deaths from CVD-related causes such as stroke and heart attack, she said.
Because these patients face such a high risk of CVD, that after lupus is diagnosed, clinicians should help patients quit smoking and improve management of high blood pressure in order to reduce deaths, she said.
In early 2018, UW Health opened Wisconsin’s first multidisciplinary Lupus and Lupus Nephritis Clinic, where Garg and study co-author Dr. Christie Bartels are part of a team that treats lupus patients.