Positive Options for Living with Lupus Read Online Free PDF Page A

characteristics suggests that vulnerability to lupus may be related to the reproductive hormone estrogen . Men also get lupus, as do children and women beyond reproductive age, but in every age group or other grouping, women always outnumber men. In children, in whom hormonal effects are presumably minimal, for each male, three girls get lupus. In adults, the ratio ranges from ten to fifteen women for each man. In older people (women beyond menopause, when the production of reproductive hormones is reduced) the ratio is approximately eight women for every man.
    Age
    As I have said, lupus strikes mostly women during their reproductive years. Sixty-five percent of patients first experience symptoms between the ages of sixteen and fifty-five. Of the remaining cases, 20 percent are affected between ages twelve and sixteen—by which age most women are sexually mature—and 15 percent after age fifty-five. Lupus does strike the very young and very old, but not sufficiently to make a statistical contribution.
    Race and Geography
    Different racial groups are more or less susceptible. This phenomenon is probably and principally related to the genetic differences between peoples. Tiny parts of the human genome— the information handed down from parent to child that programs the growth and development of the body—vary from person to person, and some genetic differences are more common in some races than others, making certain races more or less prone to certain diseases.
    In every continent, there are more cases of lupus among people of African, Hispanic, and Asian descent than among Caucasians.
    In France, immigrants from Spain, Portugal, North Africa, and Italy are more susceptible than native Frenchmen and -women. In New Zealand, both the prevalence and mortality of lupus are higher among Polynesians than Caucasians. The vulnerability of immigrant communities may be compounded by a general tendency for lupus to be more common in urban than rural communities.
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    Po s i t i v e O pt i o n s fo r L i v i n g w i t h L u p u s This tendency to affect immigrant communities disproportion-ately is something lupus shares with rheumatoid arthritis. Africans living in Africa appear less susceptible than people of African descent who live elsewhere, and certainly there is a general tendency for lupus to be more common among immigrants than among the same racial groups in their homelands, and in immigrants who move to cooler rather than tropical climes. Some researchers have suggested that this could be because immigration nearly always involves a move to cooler climes from hotter ones, and that the reduction in the amount of sunlight could play a part (see Chapter 3).
    Ethnic Variables
    In the 1990s the National Institution of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the agency in the United States concerned with rheumatic disorders, started recruiting several hundred lupus patients from various groups who were between the ages of twenty and fifty. Recruits were asked to take part in a study of all aspects of the disease, from clinical characteristics to psychological factors to genetics, including the contribution of ethnic origin to the incidence of the disease. The study, called LUMINA (which stands for LUpus in MInorities: NAture Versus Nurture), is ongoing as of this writing.
    Is It Serious, Doctor?
    Differences in the disease’s severity and long-term outcome also occur between different groups. For example, black or dark-skinned people—people originating in tropical countries—have a poorer prognosis. Some studies also suggest that lupus is worse among those with less education and those from lower socioeconomic groups, though this may reflect the fact that such groups often have poorer access to health care or may fail to follow treatment and health guidelines (known to doctors as poor compliance).
    But these days, can lupus be fatal? The short answer is very