Racial Discrimination, Disease Activity, and Organ Damage: The Black Women's Experiences Living with Lupus (BeWELL) Study.

African American women are disproportionately impacted by systemic lupus erythematosus (SLE), a chronic, potentially debilitating autoimmune disease; and also experience more rapid progression and worse outcomes compared to other groups. This study examined if racial discrimination is associated with disease outcomes among 427 African American women with a validated diagnosis of SLE in the Atlanta, Georgia metropolitan area, recruited to the Black Women's Experiences Living with Lupus (BeWELL) Study (2015-2017). Frequency of self-reported experiences of racial discrimination in domains such as employment, housing, and medical settings was assessed using the Experiences of Discrimination measure. SLE activity in the previous three months, including symptoms of fatigue, fever, skin rashes, and ulcers, was measured using the Systemic Lupus Activity Questionnaire; irreversible damage to an organ or system was measured using the Brief Index of Lupus Damage (BILD). Multivariable linear regression analyses examining the Systemic Lupus Activity Questionnaire and log-transformed BILD scores indicated that increasing frequency of racial discrimination was associated with greater SLE activity (b=2.00, 95% CI=1.32, 2.68) as well as organ damage (b=0.08, 95% CI=0.02, 0.13). Results suggest that comprehensive efforts to address disparities in SLE severity should include policies that address issues of racial discrimination.