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Lupus is a serious disease that can affect virtually any organ in the body. It disproportionately affects women and members of racial and ethnic minorities. It is well known that persons with SLE of lower socioeconomic status have poorer outcomes of disease and higher death rates. Because of the complexity of the disease, it requires access to a myriad of health professionals. For those with onset as children, there is a need to transition from pediatric to adult care just at a point in life when most of us do not have to focus on health care for ourselves. The combination of increased prevalence among minorities and women and need to have access to a wide range of health care services makes SLE an important case study of how people of a racial or ethnic minority or another group facing discrimination or disadvantaged due to having low incomes fare in the U.S. health care system.
Lupus results when the immune system fails to limit its attack to invading pathogens, such as bacteria and viruses, and instead attacks the body's own tissues. In some patients, the attack is focused primarily on the skin. However, in the majority of patients, the attack has broader effects throughout the body, in which case the disease is called systemic lupus erythematosus (SLE). SLE commonly causes arthritis, but it may also threaten life-sustaining organs including the kidneys, heart, lungs, brain, and blood. The effects of lupus on quality of life and, in many patients, length of life are profound. The cause of lupus is not known, but it appears that genetic, hormonal, and environmental factors all play a role in susceptibility.
Researchers have long known that women and members of several racial and ethnic minorities have higher rates of SLE, particularly African-Americans, Asian-Americans, NativeAmericans and Hispanics. Recent research has begun to identify genes and environmental triggers that may partially explain these differences. As a result of the wide range of genetic and environmental factors associated with the development of SLE and the broad array of clinical manifestations, it is not surprising that the onset of the disease takes many forms. Some people with SLE notice the profound fatigue first, others develop a rash after sun exposure, while others complain of joint pain. Still others only receive a diagnosis after they present to an emergency department and are hospitalized for severe internal organ involvement.
Because the path to diagnosis differs so much among patients, the types of physicians initially involved in the care of SLE also vary. Family physicians, pediatricians, and general internists are often the first physicians involved in the early stages when patients first come to the attention of the medical care system, buteventually specialists are typically involved. Depending on the symptoms, rheumatologists, dermatologists, nephrologists, cardiologists, neurologists, psychiatrists, or others may become key caregivers.
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