Why Is There a Higher Prevalence of Lupus SLE Found Among Females of Afro Caribbean Origins - Literature review Example

Lupus SLE is a medical condition that is difficult to diagnose, and treat. This is because of the complexity of the disease. People who are vulnerable to Lupus SLE are women. Nine in every ten people suffering from this disease are women. There are a variety of factors that is responsible for making these people to be vulnerable to Lupus SLE, and this includes the genetic makeup of women, environmental factors, and socio economic factors. Genetics normally involves the hormonal imbalances in women. This are usually brought about by the use of contraceptives, and changes in the hormonal make up of a woman, based on the hormonal therapies that they usually undertake. These hormonal imbalances have the capability of changing the genetic makeup of an individual, resulting to the development of Lupus SLE. However, it is important to explain that genetics alone is not the factor responsible for the development of Lupus SLE amongst women. Another important factor is the environment. The environment plays a role in the development of Lupus SLE because of the ultra violet rays of the sun. Research indicates that women, who are heavily exposed to the ultra violet rays of the sun, are always vulnerable to developing Lupus SLE. In terms of ethnicity, Lupus is more common in people of African descent. One of the major reasons advanced, is because of the high rates of poverty amongst these people, making them to be unable to afford medical treatments in regard to the type of contraceptives to use. In as much as this is information that has been given, this fact is disputed, because hormonal changes are not the only factors responsible for the high rate of Lupus amongst women. This paper is a critical analysis of the ethnic and sex differences in the epidemiology and clinical course of lupus. Introduction: This paper will analyze the ethnic and sex differences in the clinical and epidemiology course of Lupus. In meeting the objective of this paper, there will be a need of understanding the genetic predisposition of Lupus. This is important in helping us to understand why women and people of African origin are vulnerable to an attack by Lupus. Furthermore, for purposes of understanding this disease, and its epidemiological and clinical cause, there will be a need of identifying its causes. These are well explained in this paper. This paper would also identify and explain the neuropsychiatric consequences of lupus, and an example is the Lupus fog. It would further explain the epidemiology of this disease, and this is in relation to ethnicity. This paper would then build on this information to identify the reasons why certain ethnic communities are vulnerable to Lupus, and why other ethnic communities, are not vulnerable, after which, it would identify the risk factors of this disease, and answer the question on whether ethnicity plays a role in promoting the severity of the disease. Ethnic and sex differences in the epidemiology and clinical course of lupus Genetic predisposition refers to the development of a disease or medical condition through inheritance. Genetic predisposition is one of the major factors that lead to the development of Lupus (Phillips, 2001). Phillips (2001) in their analysis of the diseases that are inherited explains that parents are always responsible for passing Lupus to their children. Phillips (2001) further explains that approximately, 5 to 12 % of patients suffering from Lupus inherited this medical condition from their parents. Through this percentage, it is possible to denote that not every cases of Lupus are inherited. This is because there are certain environmental factors that are responsible for the development of Lupus. This is a view that is shared by Moore (2000). Moore (2000) argues that not a single factor is able to cause the emergence of this disease. This is because there are many factors at play, and this includes the genetic composition of an individual, the environmental composition, and the social factors that surround the person under consideration (Ginzler & Dooley, 2014). Through this argument, we are able to denote that Lupus is not formed by genes alone, but other factors are also at play, hence it is a complex disease, and a difficult one to diagnose. This is an aspect that is shared by Moore (2000). Moore (2000) is talking from experience, and she is denoting that it took five years for doctors to diagnose her ailment, and that she was suffering from Lupus. This length of time emanated because of the inability of the doctors to correctly identify the symptoms of Lupus, and the reasons that causes its emergence. These are the genetic, environmental, and social factors. Moore (2000) explains that infectious agents, like bacteria and viruses also play a role in causing the emergence of Lupus, and also the ultra violet rays of the sun. In their explanation of the genetic predisposition of Lupus, Wallace, Hahn & Dubois (2007) provide a critique of the arguments that are developed by Moore (2000). Wallace et al (2007) explains that for this disease to occur there must be a genetic trigger. Through this argument, Wallace et al (2007) believes that an individual cannot suffer from this disease, unless one of their parents or relatives was suffering from Lupus. In diagnosing this disease, Wallace et al (2007) therefore assert that the first method and process, is to analyze the genetic composition of an individual, and this may be a scientific and historical process. It is a scientific process because there is a need of using the laboratory for purposes of analyzing the genetic composition of an individual, and using history, for purposes of finding out whether a family member of a patient is suffering from this disease, or was suffering from it (González, Toloza & Alarcón, 2014). It is only through this method that medical practitioners can efficiently and effectively diagnose an individual, as suffering from Lupus SLE. In their analysis of the genetic predisposition of Lupus, Wallace et al (2007) explains that the monozygotic twins and siblings are vulnerable to Lupus, when compared to the dizygo tic twins. Monozygotic are identical twins; while dizygotic are not identical twins. By denoting that monozygotic twins are vulnerable to Lupus, Wallace et al (2007) are indicating that genetics plays an important role in determining whether an individual would suffer from Lupus or not. This is because monozygotic twins emanate from one ovary, and this means the level of their genetic composition is high (Tiffin, Hodkinson & Okpechi, 2013). This therefore means that they have high chances of suffering from the same genetic disease, when compared to the dizygotic twins, who normally emanate from two ovaries, hence low chances of suffering from the same or similar genetic diseases. Moore (2000) explains the impact of genetics, in causing Lupus amongst identical and non identical twins. In their explanation, Moore (2000) gives an example of identical twins whereby one suffers from Lupus, and another one does not suffer from Lupus. In this explanation, Moore (2000) asserts that because of this incidence, genetics alone is not a factor that is responsible for causing Lupus amongst children and adults. Other factors must be considered. In her analysis therefore, Moore (2000) concludes by denoting that Lupus is not an inherited disease, in as much as genetics plays a role in determining whether an individual would suffer from it or not. However, Wallace et al (2007) provide an example of a Lupus disorder that requires the existence of a genetic triggering factor. An example includes then idiopathic Lupus that requires a multiple genetic loci, for it to occur, or to exist. This is an aspect that Phillips (2001) explains. In their analysis of the genetic predisposition of Lupus, Phillips (2001) explains that multiple genes are needed for the occurrence of the idiopathic Lupus. This means that there are people who have a high degree of genetic risk, and they tend to acquire Lupus at an earlier stage, when compared to people who have a low genetic risk, who may or may not acquire Lupus at any stage of their lives (Szebeni, 2004). Wallace et al (2007) explains that people who have a high genetic risk of acquiring Lupus normally develop stranded hematologic and anti-body disorders. This is the major reason for the different manifestation of the disease, in an individual, making it extremely difficult for the disease to be diagnosed, and treated. Wallace et al (2007) maintains that there exists not a single gene abnormality that leads to the development of Lupus SLE to an individual. This means that the genetic factors that cause Lupus are variable, and they depend upon an individual who is suffering from the disease. Furthermore, Wallace et al (2007) explains that 75% of patients suffering from Lupus have one leukocyte anti-body that has the capability of increasing the chances of an individual acquitting Lupus. These leukocyte anti-bodies include, DR3, DR4 and even DR8. In a study carried out by Nakasato & Yung (2011), people who normally exhibit a high percentage of these anti-bodies include the colored people. This specifically applies to people of African origin or the black people. For instance, in the same study carried out by Nakasato & Yung (2011), the results indicated that out of 100,000 people of African Caribbean, 10 people were suffering from the Lupus SLE. When this is compared to the Caucasians, on 6 people, out of every 100,000 were suffering from Lupus SLE. Therefore, Nakasato & Young (2011) assert that the reason for a high prevalence of Lupus SLE amongst people of African descent is based on the fact that they have a large presence of leukocyte anti-bodies, particularly, DR3, DR8 and DR4. These anti-bodies are risk factors that make people to be vulnerable to the germs that cause Lupus. However, Phillips (2001) explains that it is not accurate to denote the large presence of the DR3, DR8 and DR4 anti-bodies are responsible for the high prevalence of Lupus amongst the Afro-Caribbean people, when compared to the Caucasians. However, in a study conducted by Schur & Massarotti (2012), they denoted that it is wrong to assert that the prevalence of these antibodies in people of black origin is the major factor responsible for the high rates of prevalence amongst these people. This is majorly because, in their recent studies, there were indications that these anti-bodies that makes people to be vulnerable to Lupus are also found amongst the Caucasians and Asians in a higher rate (Mayilyan, 2012). In some instances, the percentage of the presence of these antibodies was higher when compared to the percentage that was found in the population, of the black people, or of the Afro-Caribbean (Schur & Massarotti, 2012). This is an indication that other factors also contribute to the development and emergence of Lupus SLE to people of African origin. As noted earlier, these factors are social and environmental. Schur & Massarotti (2012) further analyze the reasons why scientists and medical experts should be concerned on the genetic predisposition of Lupus, and its impact in accelerating the development of Lupus in an individual. In their research, the two authors concentrated on the presence of the auto-antibodies in the cells of an individual. Schur & Massarotti (2012) assert that a large proportion of people suffering from Lupus are characterized by a large presence of auto-antibodies, which are lined in their endothelial cells. On most occasions, the cells of endothelial anti-bodies are normally associated with the emergence of cardiovascular diseases, and this specifically applies to women (Costa-Reis & Sullivan, 2013). This is therefore an indication that a large percentage of women, are suffering from Lupus, when compared to men. This is a fact that Moore (2000) accepts. In her study of Lupus SLE, Moore (2000) explains that over 90% of people suffering from Lupus are women. This is a very significant number of people, indicating that only 10% of people suffering from the Lupus disorder are male. Legato & Bilezikian (2004) have carried out varies studies, in a bid to explain the reasons for the vulnerability of women to Lupus SLE. One of the major reasons for the occurrence of this disease amongst women is based on the different hormonal balance that occurs between women and men (Herrera, 2011, Smolen & Zielinski, 1987). In their study, Legato & Bilezikian (2004) explain that Lupus SLE was very common amongst women, who were in their productive age. This means that women between the ages of 18 to 55 years are vulnerable to contracting Lupus SLE. In their analysis of the major factor responsible for causing this disease, Legato & Bilezikian (2004) explains that the hormonal factors responsible for causing this disease are brought about, because of the use of oral contraceptives amongst women. Wallace et al (2007) in their explanation of the reasons for the high percentage of women suffering from Lupus, agrees with the results of the experiments and study conducted by Legato & Bilezikian (2004). Wallace et al (2007) goes further to identify specific oral contraceptives, and hormonal replacement programs that make women to be vulnerable to the disease. For instance, oral contraceptives that contain estrogenic compounds normally have a high percentage of causing Lupus amongst women. Furthermore, hormonal replacement therapies, that contained conjugated estrogens, have been accused for increasing the development of Lupus amongst women (Lahita, 2010). Therefore, this means that hormonal changes brought about by the injection and use of drugs, or introduced through therapies are the major reasons for the high rate of the development of Lupus SLE amongst women (Meszaros, Perl & Faraone, 2012). In as much as hormonal factors are responsible for the development of Lupus amongst women, the self structure of the auto-anti bodies also play a role in the development of this medical condition amongst women. In her explanation of the causes of Lupus SLE in women, Moore (2000) maintains that the immune body complexes in the body system of women, is different from that of men, and this is a factor that is responsible for causing a high percentage of Lupus in women, when it is compared to that of men. The immune complex of an individual comprises of a conglomerate of anti-bodies, viruses and antigens in the blood system of an individual (Santer, Wiedeman, Teal, Ghosh & Elkon, 2012). In the view of Moore (2000), it is normally difficult for the body of a woman to break these immune complex substances in their blood system. This is when it is compared to the immune complex system of men. Furthermore, these immune complex systems have the capability of destroying or causing inflammation to the tissues of the body system, leading to the development of Lupus. Through this process, Moore (2000) explains that Lupus is therefore more common in women, as compared to men, and this is because of the existence of a high percentage of the immune complexes in their body system. Unfavorable environmental condition is another factor that is responsible for the high percentage of Lupus amongst women, and people of Afro Caribbean origin (Rullo & Tsao, 2012). One such environmental factor is the ultra-violent lights that emanates from the sun. In a research conducted by Wallace et al (2007), they explain that people, who are constantly exposed to the ultra violet rays of the sun, are always vulnerable to the development of Lupus. This specifically applies to women, because of the inability of their body systems to efficiently break down their immune complex systems. Wallace et al (2007) supports the notion that women are of higher risks in contracting this disease, when compared to men. For example in a study conducted by Linan-Rico (2015), 1 out of every 500 people with Afro Caribbean roots explains that they are suffering from the disease. This is when it is compared to 1 in every 2500 women of Caucasian origin (Linan-Rico, 2015). Indian women are also vulnerable to this disease, and the rates stand at 1 in every 1000 women. This is twice the rates that are depicted amongst women of Afro-Caribbean origin. Through these results, we are able to find out that women are the major people suffering from Lupus, however, race and ethnicity also plays a role in determining the rates in which these women are suffering from the disease. The highest rates are found amongst women with African descent, and this is specifically, women within the ranges of 20 to 49 years (Liñán-Rico, 2015). These are women within the child bearing range, and a better explanation is the hormonal changes brought about by an increase in the use of oral contraceptives, and hormonal therapies (Kuhn, Lehmann & Ruzicka, 2005). A series of studies that have been conducted in United States confirms this assertion, which depicts that people of black descent are always vulnerable to Lupus. From the results of these studies, hormonal changes in women are not the only factors responsible for causing Lupus amongst them (Nikpour, Gladman & Urowitz, 2013). Other factors include the environment in which they reside in, and their exposure to the ultra violet rays of the sun. Women of African descent are always exposed to these rays, because of their lifestyles. Most of them live in poor countries such as Jamaica, Cuba, etc, and they normally wake up early, hence they are exposed to the ultra violet rays of the sun. This in turn affects their complex immune systems, which makes it difficult for their body system to breakdown vitamin D, which results to the emergence of skin rashes, and the Lupus disorder (Lewis, 2010). Therefore, in the view of Somers et al (2014), women of African descent are vulnerable to Lupus SLE because of their lifestyle. This is when compared to the lifestyles of Caucasians, Indians, and other Asian women (Balch, 2006). However, Linan-Rico (2015) disputes this assertion, and he claims that even in developed countries, where these women have a better lifestyle, they are also vulnerable to Lupus SLE. They bring up the concept of the genetic makeup of these women, to explain the reasons for the high rates of Lupus SLE amongst women. Linan-Ricoh (2015) believes that hormonal factors are the major reasons for the development of Lupus in women with African descent. This is basically because they are responsible for using oral contraceptives, without the direction and prescription from the doctors (Gordon, Smolen & Tsokos, 2007). This is majorly because of poverty, and their inability to afford professional help, emanating from medical practitioners, who may prescribe to them, the best contraceptives that they can use (Mattsson, 2014). Poverty is a social and an economic issue, therefore Linan-Ricoh (2015) asserts that the major cause of a high rate of Lupus SLE is poverty, and to solve this issue, there is a need of coming up with policies whose aim is to reduce poverty amongst women of African origin. This includes the introduction of policies whose major aim is to make women self-sufficient, and capable of taking care of them-selves (Guerra, Vyse & Graham, 2012). Poverty also causes women to be unable to afford better and high quality food substances, making them vulnerable to eating food substances that have the capability of increasing their chances of getting Lupus SLE. An example of such kind of a food substance is the Alfafa sprout. This is an environmental factor, responsible for causing Lupus SLE (Nikpour, Gladman & Urowitz, 2013). Alfafa Sprout is a food substances have the capability of aggravating the auto-immune problems, which in turn lead to the development of skin rushes, and other sign of Lupus SLE. Stress is also another factor that is responsible for causing Lupus SLE. An example is a prolonged stress, which is the major cause of the Lupus flares. In examining the neuropsychiatric consequences of lupus, Moore (2000), more explains that the lupus fog is one of its main consequences. The lupus fog refers to a situation where an individual is suffering from memory loss, and it is also referred to as forgetfulness. This is one of the most frustrating elements and symptoms that face an individual who is suffering from Lupus (González, Toloza & Alarcón, 2014). This type of situation is not only concerned with memory loss, but there are other cognitive problems associated with it. Examples include the inability of mothers to help their children with school work, basically because they do not understand the simple mathematical problems that their children have to solve (Magder & Petri, 2012). This therefore means that Lupus would also affect the brain of women, limiting their ability to reason efficiently, and in a manner that is useful to them (Seward, 2007). However, one of the major signs of Lupus fog, are the confusions that women suffering from this condition normally experience. This includes confusions in the manner which they are interacting with their friends, relatives, and other influential people in their lives (Costenbader & Schur, 2014). Furthermore, Lupus fog is characterized by the inability of a woman to efficiently and effectively communicate with other people. Based on these facts, women suffering from Lupus fog are always encouraged to visit speech therapists and psychologists (Balch, 2006). Conclusion: Lupus is an example of a chronic disease whose etiology is not known. Because of the nature of the disease, it is a very difficult process for doctors and other medical practitioners to diagnose and treat Lupus. Therefore, people suffering from this disease are normally treated at a later stage. Lupus is an example of an auto-immune illness, and therefore, the use of biological therapy has been essential in the treatment of these types of illnesses. However, when it comes to Lupus, biological therapies have never been efficient and effective in their treatment. The inability to treat this disease is not based on lack of research in the area, but it is because of the complex nature of this disease. Furthermore, there is a misunderstanding on the process of diagnosing this disease, and the instruments to use. This is the major reason for the inability of medical practitioners to diagnose and treat this disease at an early stage. There is a dilemma on whether to consider Lupus as one disease, or as many diseases. This is because Lupus normally manifests itself in a variety of methods, and the clinical manifestation of this illness is dependent on the human organ that it has attacked. However, there are three important facts that are attributed to Lupus. These facts are, that the most vulnerable group that the disease attacks are women, it attacks specific ethnic and racial groups, basically because of their genetic composition, and there is an elusive trigger to the emergence of this disease in an individual. Environmental factors also play a role in determining whether an individual would acquire Lupus SLE or not. One of the major environmental factors responsible for the development of Lupus SLE is the ultra violet rays of the sun. This is a triggering factor, in the development of Lupus SLE amongst women, and other people who are vulnerable to it. An important socio-economic factor that is responsible for the development of Lupus SLE is poverty. This is a major reason given by scholars such as Moore (2000), who explain that, because of a high rate of poverty, women of African descent are always vulnerable to developing Lupus SLE. Therefore, the best method of reducing these rates of Lupus SLE amongst people of African descent is to reduce the rates of poverty amongst them. Bibliography: Top of Form BALCH, P. A. (2006). Prescription for nutritional healing. New York, Avery. Bottom of Form COSTA-REIS, P., & SULLIVAN, K. E. (2013). Genetics and epigenetics of systemic lupus erythematosus. Current rheumatology reports, 15(9), 1-9. COSTENBADER, K. H., & SCHUR, P. H. (2014). We need better classification and terminology for “people at high‐risk of or in the process of developing lupus”. Arthritis care & research. GINZLER, E. M., & DOOLEY, M. A. (2014). Systemic lupus erythematosus. Top of Form GORDON, C., SMOLEN, J. S., & TSOKOS, G. C. (2007). Systemic lupus erythematosus: a companion to Rheumatology. Philadelphia, Mosby. Bottom of Form GONZÁLEZ, L. A., TOLOZA, S. M., & ALARCÓN, G. S. (2014). Impact of Race and Ethnicity in the Course and Outcome of Systemic Lupus Erythematosus. Rheumatic Disease Clinics of North America, 40(3), 433-454. GUERRA, S. G., VYSE, T. J., & GRAHAM, D. S. C. (2012). The genetics of lupus: a functional perspective. enzyme, 2, 3. Top of Form HERRERA, G. A. (2011). Experimental models for renal diseases: pathogenesis and diagnosis. Basel, Karger. Top of Form KUHN, A., LEHMANN, P., & RUZICKA, T. (2005). Cutaneous lupus erythematosus. Berlin, Springer. Bottom of Form Bottom of Form Top of Form LAHITA, R. (2010). Systemic Lupus Erythematosus. Academic Press. Top of Form LEGATO, M. J., & BILEZIKIAN, J. P. (2004). Principles of gender-specific medicine. Amsterdam, Elsevier Academic Press. Top of Form LEWIS, E. J. (2010). Lupus nephritis. Oxford, Oxford University Press. Bottom of Form LIÑÁN-RICO, L., HERNÁNDEZ-CASTRO, B., DONIZ-PADILLA, L., PORTILLO- SALAZAR, H., BARANDA, L., CRUZ-MUÑOZ, M. E., & GONZÁLEZ-AMARO, R. (2015). Analysis of expression and function of the co-stimulatory receptor SLAMF1 in immune cells from patients with systemic lupus erythematosus (SLE). Lupus, 0961203315584412. MATTSSON, M. (2014). Patients’ experiences and patient-reported outcome measures in systemic lupus erythematosus and systemic sclerosis. Bottom of Form Top of Form MOORE, S. (2000). Lupus: alternative therapies that work. Rochester, Vt, Healing Arts Press. Top of Form NAKASATO, Y., & YUNG, R. L. (2011). Geriatric rheumatology a comprehensive approach. New York, Springer. Bottom of Form NIKPOUR, M., GLADMAN, D. D., & UROWITZ, M. B. (2013). Premature coronary heart disease in systemic lupus erythematosus: what risk factors do we understand?. Lupus, 22(12), 1243-1250. MAGDER, L. S., & PETRI, M. (2012). Incidence of and risk factors for adverse cardiovascular events among patients with systemic lupus erythematosus. American journal of epidemiology, 176(8), 708-719. MAYILYAN, K. R. (2012). Complement genetics, deficiencies, and disease associations. Protein & cell, 3(7), 487-496. MESZAROS, Z. S., PERL, A., & FARAONE, S. V. (2012). Psychiatric symptoms in systemic lupus erythematosus: a systematic review. The Journal of clinical psychiatry, 73(7), 993- 1001. RULLO, O. J., & TSAO, B. P. (2012). Recent insights into the genetic basis of systemic lupus erythematosus. Annals of the rheumatic diseases, annrheumdis-2012. Top of Form SZEBENI, J. (2004). The complement system: novel roles in health and disease. Boston, Kluwer Academic Publishers. Bottom of Form Bottom of Form Top of Form PHILLIPS, R. H. (2001). Coping with lupus: a practical guide to alleviating the challenges of systematic lupus erythematosus. New York, Avery. SANTER, D. M., WIEDEMAN, A. E., TEAL, T. H., GHOSH, P., & ELKON, K. B. (2012). Plasmacytoid dendritic cells and C1q differentially regulate inflammatory gene induction by lupus immune complexes. The Journal of Immunology, 188(2), 902-915. Top of Form SEWARD, T. I. (2007). Progress in systemic lupus erythematosus research. New York, Nova Biomedical Books. Bottom of Form SCHUR, P. H., & MASSAROTTI, E. M. (2012). Lupus erythematosus clinical evaluation and treatment. New York, NY, Springer. SMOLEN, J. S., & ZIELINSKI, C. C. (1987). Systemic Lupus Erythematosus Clinical and Experimental Aspects. Berlin, Heidelberg, Springer Berlin Heidelberg. TIFFIN, N., HODKINSON, B., & OKPECHI, I. (2013). Lupus in Africa: can we dispel the myths and face the challenges?. Lupus, 0961203313509296. Bottom of Form Top of Form WALLACE, D. J., HAHN, B., & DUBOIS, E. L. (2007). Dubois lupus erythematosus. Philadelphia, Lippincott Williams & Wilkin. Read More