Elevated C-reactive protein and self-reported disease activity in systemic lupus erythematosus.

C-reactive protein (CRP), a biomarker of inflammation, has been associated with increased disease activity in rheumatoid arthritis. However, the association in systemic lupus erythematosus (SLE) remains unclear. We examined the association of CRP with self-reported disease activity in the Carolina Lupus Study and described differences by sociodemographic characteristics. The study included baseline and three-year follow-up data on 107 African-American and 69 Caucasian SLE patients enrolled at a median 13 months since diagnosis. Models estimated prevalence differences in the association of baseline CRP with self-reported flares, adjusting for age, sex, race and education. Active disease or flare was reported by 59% at baseline and 58% at follow-up. Higher CRP (>10 µg/ml vs. <3 µg/ml) was associated with a 17% (95% confidence interval (CI): -20, 53%) higher prevalence of flare at baseline and a 26% (95% CI: -9, 62%) higher prevalence of flare at follow-up. These CRP-flare associations were notably stronger in patients with lower education at baseline and in African-Americans at follow-up. These findings suggest that CRP may be a useful marker in studies of SLE health disparities.

Development and reliability of a Telephone-Administered Perceived Racism Scale (TPRS): a tool for epidemiological use.

The conceptualization of perceived racism as a chronic stressor is relatively new to epidemiology. The Telephone-Administered Perceived Racism Scale (TPRS) captures the complexity of racism within five scales: Experience of Racism (by Blacks as a group and by the respondent), Emotional Responses, Behavioral Responses, Concern for Child(ren), and Past Experiences of Racism. The TPRS was developed for employed Black women. Exploratory factor analyses and tests of internal consistency were completed with 476 Black women, aged 36-53. Factor analyses on their responses to racism yielded five factors: passive emotions, active emotions, passive behaviors, internal active behaviors, and external active behaviors. Alpha reliability values ranged from 0.75 to 0.80 for the active and passive emotions subscales, from 0.59 to 0.69 for the passive behaviors subscale, and greater than 0.76 for both active behaviors subscales. Alpha reliabilities were 0.82, 0.90, 0.88, and 0.82 for Past Experiences, Concern for Child(ren), Experience of Racism--Personal, and Experience of Racism--Group, respectively. Another 30 Black women were queried for test-retest reliability, with values ranging from 0.61 to 0.82. The TPRS was found to be reliable and should serve as a useful epidemiological tool in the examination of the effects of perceived racism on Black women's health.