Purpose Sex steroids have differential effects on lymphocyte function that may be relevant to the development of autoimmune diseases such as systemic lupus erythematosus (SLE). We examined sex steroid levels in white and black women with recent-onset SLE to determine whether black women had a more immunostimulatory sex steroid phenotype that might be associated with their propensity to earlier onset and more severe SLE.
Methods Healthy premenopausal women with SLE for less than 5 years were enrolled. A standardized disease activity measure (Systemic Lupus Activity Measure or SLAM) was performed, and a blood sample was taken to measure hormone levels. Hormones were measured by EIA in our laboratory (progesterone, estrogen, androstenedione) or in the laboratory of our university hospital (prolactin and testosterone).
Results Thirty-three black and 14 white women were enrolled. The black women were younger (31.6 vs 38.8 yr, p > .05). Clinical disease was similar (ACR criteria, SLAM score, patient and MD global assessment). Estrogen (32.7 6 15.9 vs 27.0 6 18.4 pg/mL) and progesterone (1,346 6 2,561 vs 2,256 6 3,588 pg/mL) were statistically similar (p > .05) in black and white women, respectively. PRL, known to be higher in SLE than normals, was above normal (upper limit 17.9 ng/mL) in 7/30 black and 1/14 white women (RR 3.3). PRL was 19 6 20 vs 14 6 8 ng/mL (p > .05), respectively. Testosterone trended higher (15.4 6 13.3 vs 11.9 6 13.4 ng/mL), and androstenedione was significantly higher in white women (1,582 6 980 vs 947 6 593 pg/mL, p = .009).
Conclusion The propensity of young black females to earlier onset and more severe SLE may be due in part to the immunologic effects of lower androgen levels and higher prolactin compared to their white counterparts.
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