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DIANELIS LOPEZ, Harvard College '22

Developing Novel Therapuetics for Systemic Lupus Erythematosus Through the Analysis of Gender, Race, and Ethnicity Components

THURJ Volume 13 | Issue 2


Autoimmune diseases occur when the body's defense
mechanism i.e. the immune system fails to recognize self- "Comparing the manifestation of lupus across
antigens and attacks healthy tissues, leading to damage. There has always been a need to understand how autoimmune diseases develop and, more recently how gender, race, and ethnicity play a role in the disease progression. For example, systemic lupus erythematosus (SLE) is an autoimmune disease that can lead to skin lesions, joint damage and kidney disease such as lupus nephritis.1 Research has shown that demographic factors may impact the progression of SLE and lead to more severe versions of the disease, among these factors are gender, ethnicity, race, and perception of healthcare. Young women between adolescence and menopause are disproportionately affected by lupus, indicating that sex chromosome related genes and sex hormones may be implicated in its pathogenesis.”2 However, the differences in gene profiles between women and men with SLE are still not fully known. Additionally, racial and ethnic minorities are more severely impacted by SLE. Although race and ethnicity are not necessarily associated with a higher prevalence, they are associated with a more severe progression of the disease that lead to more organ complications. Awareness of how this disease disproportionately affects some subgroups of the population calls for the need to develop novel therapeutics
different ethnic and racial groups has revealed pathological discrepancies"
Comparing the manifestation of lupus across different ethnic and racial groups has revealed pathological discrepancies, which indicates that lupus causes more severe symptoms for Blacks, Asian/ Pacific Islander, and Hispanics.3 The difference in disease progression involved kidney abnormalities, neurological manifestations, and blood manifestations.4 This led to a greater risk of showing symptoms of lupus nephritis, thrombocytopenia, and antiphospholipid syndrome. Through several epidemiological studies, it has been proposed that lupus pathogenesis is impacted by genetic profiles and differences in environment. Accounting for these confounding factors could direct research towards the development of novel therapeutics that focus on specific pathways related to ethnicity or race. The current treatment options for lupus involve taking anti- inflammatory agents and immunosuppressive drugs; however, there haven't been significant efforts in researching gender or ethnic/racial specific pathways.

Aside from the biological differences across different populations, it is also important to account for a patient's personal experiences and how that might affect their disease. When studying diseases, researchers tend to primarily focus on the biological components and ignore the impact of personal narratives on disease development.5 As mentioned earlier, it seems as if ethnicity and race are significant predictors for the progression of systemic lupus erythematosus; however, the research on this area is limited. Most of the studies available tend to study genetic differences, rather than exploring other categorical predictors, such as immigration status or socioeconomic background. These factors tend to be significant predictors when assessing an individual's perception of healthcare. Healthcare perception might be impacted by cultural values which influenced how a person views a disease and the treatment options they are willing to follow. When prescribing a treatment plan, a physician needs to account for patient compliance and adherence to the ‘medication suggested. For groups that have suffered from marginalization and exploitation, there are underlying factors that contribute towards government mistrust.5 This phenomenon can be viewed when patients refuse to follow a suggested treatment plan due to incongruencies with their culture. Usually, the patient does not communicate these conflicts to the doctor, and the doctor remains unaware. Additionally, factors such as language barriers are usually associated are usually associated with a more severe progression of disease given that these patients are more prone to not comply with physician's recommendations given a lack of understanding.

Given the impact these factors can have on disease development, there should be tailored cultural interventions that are designed in order to improve the perception of healthcare resources, which would ameliorate the health disparities.5 If populations from different ethnicities and races start to seek medical treatment at the same rate, then the advancement of severe versions of disease could become more controlled. Additionally, adjusting for these components could also inform the process of developing more targeted treatment delivery that maximize patient compliance by considering cultural factors. Usually, minority groups might feel disenfranchised by the system and struggle to seek medical attention. This could inadvertently lead to the development of more severe symptoms that could have been preventable. It is important to develop a preventive healthcare model where individuals can avoid extreme symptoms, instead of attempting to treat preventable symptoms. The success of a treatment plan is not only dependent on the efficacy of the medication, but also on the equitable distribution of the treatment and the ability of the patient to adhere to such treatment. The road to minimize healthcare disparities when referring to SLE is dependent on developing more comprehensive - research studies that adjust for significant factors in disease development.

1. Feldman, C. H., Hiraki, L. T., Liu, J., Fischer, M. A., Solomon, D. H., Alarcón,
G. S., Winkelmayer, W. C., & Costenbader, K. H. (2013). Epidemiology and sociodemographics of systemic lupus erythematosus and lupus nephritis among US adults with Medicaid coverage, 2000-2004. Arthritis and rheu- matism, 65(3), 753–763.
2. Drenkard, C., & Lim, S. S. (2019). Update on lupus epidemiology: advanc -
ing health disparities research through the study of minority populations. Current opinion in rheumatology, 31(6), 689–696. BOR.0000000000000646
systemic lupus erythematosus in Taiwan: a nationwide population-based
study. Sci Rep 11, 5631 (2021).
4. Isenberg, D., Appel, G. B., Contreras, G., Dooley, M. A., Ginzler, E. M.,
Jayne, D., Sánchez-Guerrero, J., Wofsy, D., Yu, X., & Solomons, N. (2010).
race/ethnicity on response to lupus nephritis treatment: the ALMS study. Rheumatology (Oxford, England), 49(1), 128–140. rheumatology/kep346
5. Rodgers, W., Williams, E. M., Smalls, B. L., Singleton, T., Tennessee, A., Kamen, D., & Gilkeson, G. (2020). Treating Systemic Lupus Erythematosus
- ceptions and Decision-Making in Charleston, South Carolina. International
journal of environmental research and public health, 17(7), 2285. https://

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