{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T21:13:29Z","timestamp":1777929209609,"version":"3.51.4"},"reference-count":30,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lupus"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate ethnic disparities among patients with systemic lupus erythematosus (SLE) managed within a universal, publicly funded healthcare system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Cross-sectional study based on a retrospective review of medical records of patients with SLE who attended the rheumatology outpatient clinics of the Hospital Fundaci\u00f3n Jim\u00e9nez D\u00edaz (Madrid, Spain) between 2023 and 2024. Eligible patients were those who had been followed in the unit at any time between 2010 and 2024 and who met well-established criteria for SLE. Patients of ethnically Spanish origin were classified as Spaniards, while those identified as Latin American (including individuals from South and Central America, and Brazil), Asian, or of African descent were grouped as non-Spaniards. Disease activity was assessed using the SLEDAI and SLEDAS scores, as well as the DORIS remission criteria. Comparative analyses included clinical features, disease activity, and treatment. Group comparisons were performed using the Mann-Whitney U test, Student's t-test, chi-squared test, or Fisher\u2019s exact test, as appropriate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the cohort of 324 SLE patients, 42.3% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 137) were non-Spaniards, primarily Latin American (88.3%), followed by Asian (10.2%) and individuals of African descent (1.5%). No significant differences were observed in clinical manifestations or lupus nephritis histology. However, antiphospholipid syndrome was more frequent among Spaniard patients (13.9%) compared to non-Spaniard patients (6.6%) (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.04). In contrast, anti-Sm antibodies were more commonly detected in non-Spaniards (26.3% vs 16.6%;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.03). Non-Spaniard patients exhibited greater disease activity, with higher mean SLEDAI-2K scores (mean \u00b1 standard deviation: 1.80 \u00b1 2.65 vs 1.26 \u00b1 1.84;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.03) and SLE-DAS scores (2.06 \u00b1 3.26 vs 1.34 \u00b1 1.89;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.01), as well as significantly lower DORIS remission rates (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.03) compared to Spaniard patients. Current prednisone use was 41.3% among non-Spaniard patients versus 24.7% in Spaniards. The use of immunosuppressants was similar between the two groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In a universal public healthcare system, we did not observe major ethnic disparities in clinical manifestations of SLE. Nonetheless, non-Spaniard patients showed higher disease activity, lower remission rates, and greater glucocorticoid use, suggesting differences in disease expression rather than inequities in care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09612033261422634","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T20:01:30Z","timestamp":1769630490000},"page":"378-386","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Ethnic differences in disease activity among patients with systemic lupus erythematosus in a universal public healthcare system"],"prefix":"10.1177","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7703-3380","authenticated-orcid":false,"given":"Elena","family":"Heras-Recuero","sequence":"first","affiliation":[{"name":"Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ant\u00eda","family":"Garc\u00eda-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Quiroga-Colina","sequence":"additional","affiliation":[{"name":"Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"G\u00f3mez-Moreno","sequence":"additional","affiliation":[{"name":"Autonomous University of Madrid"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arantxa","family":"Torres-Rosell\u00f3","sequence":"additional","affiliation":[{"name":"Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ra\u00fal","family":"Fern\u00e1ndez-Prado","sequence":"additional","affiliation":[{"name":"Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alejandro","family":"Avello","sequence":"additional","affiliation":[{"name":"Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raquel","family":"Largo","sequence":"additional","affiliation":[{"name":"Joint and Bone Research Unit, Service of Rheumatology, IIS-Fundaci\u00f3n Jim\u00e9nez D\u00edaz UAM"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0197-5267","authenticated-orcid":false,"given":"Ivan","family":"Ferraz-Amaro","sequence":"additional","affiliation":[{"name":"Hospital Universitario de Canarias"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier","family":"Llorca","sequence":"additional","affiliation":[{"name":"University of Cantabria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7924-7406","authenticated-orcid":false,"given":"Miguel \u00c1ngel","family":"Gonz\u00e1lez-Gay","sequence":"additional","affiliation":[{"name":"Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz"},{"name":"University of Cantabria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1080\/1744666X.2017.1327352"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2009.12.008"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1100359"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keac610"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-223035"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0b013e328323daad"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kep346"},{"key":"e_1_3_5_9_2","first-page":"680","article-title":"Racial differences in treatment preferences among lupus patients: a two-site study","volume":"32","author":"Vina ER","year":"2014","unstructured":"Vina ER, Utset TO, Hannon MJ, et al. Racial differences in treatment preferences among lupus patients: a two-site study. Clin Exp Rheumatol 2014; 32: 680\u2013688.","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.3949\/ccjm.79a.12048"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2016.137"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780400928"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.34473"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2018-214819"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-1755.2004.00443.x"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2017.11.023"},{"key":"e_1_3_5_17_2","first-page":"288","article-title":"Systemic lupus erythematosus disease activity index 2000","volume":"29","author":"Gladman DD","year":"2002","unstructured":"Gladman DD, Iba\u00f1ez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol 2002; 29: 288\u2013291.","journal-title":"J Rheumatol"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2018-214502"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2025.152758"},{"issue":"11","key":"e_1_3_5_20_2","first-page":"S37","article-title":"Measures of adult systemic lupus erythematosus","volume":"63","author":"Romero-Diaz J","year":"2011","unstructured":"Romero-Diaz J, Isenberg D, Ramsey-Goldman R. Measures of adult systemic lupus erythematosus. Arthritis Care Res 2011; 63(Suppl 11): S37\u2013S46, updated version of British Isles Lupus Assessment Group (BILAG 2004), European Consensus Lupus Activity Measurements (ECLAM), Systemic Lupus Activity Measure, Revised (SLAM-R), Systemic Lupus Activity Questionnaire for population studies (SLAQ), Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), and Systemic Lupus International Collaborating Clinics\/American College of Rheumatology Damage Index (SDI).","journal-title":"Arthritis Care Res"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2015-207726"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2021-000538"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.2022-1300"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2024-001383"},{"key":"e_1_3_5_25_2","first-page":"2228","article-title":"The impact of social inequities on presentation of juvenile-onset systemic lupus erythematosus at a large tertiary center","volume":"19","author":"Beil EF","year":"2025","unstructured":"Beil EF, DeGuzman M, Ramires A, et al. The impact of social inequities on presentation of juvenile-onset systemic lupus erythematosus at a large tertiary center. J Clin Rheumatol 2025; 19: 2228.","journal-title":"J Clin Rheumatol"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr.25314"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2665-9913(23)00296-5"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/09612033231218923"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keac613"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1177\/0961203319889667"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2023-224952"}],"container-title":["Lupus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09612033261422634","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/09612033261422634","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09612033261422634","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T23:29:43Z","timestamp":1777678183000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/09612033261422634"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,28]]},"references-count":30,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1177\/09612033261422634"],"URL":"https:\/\/doi.org\/10.1177\/09612033261422634","relation":{},"ISSN":["0961-2033","1477-0962"],"issn-type":[{"value":"0961-2033","type":"print"},{"value":"1477-0962","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,28]]}}}