Purpose of Review Systemic lupus erythematosus (SLE), an inflammatory rheumatic disease characterized by autoantibody production and diverse clinical manifestations, disproportionately affects vulnerable groups: women, racial and ethnic minorities, the poor, and those lacking medical insurance and education. We summarize the current knowledge of the disparities observed in SLE and highlight recent research that aims to dissect the causes of these disparities and to identify the potentially modifiable factors contributing to them. Recent Findings Several remediable causes, including lack of education, self-efficacy, and access to quality, experienced healthcare, have been found to contribute to observed disparities in SLE prevalence and outcomes. Summary SLE is associated with alarming disparities in incidence, severity and outcomes. The causes of these disparities are under study by several research groups. Identifying potentially correctable contributory factors should allow for the development of effective strategies to improve the healthcare delivery and outcomes in all SLE patients.

Objectives Quality indicators (QIs) for assessment of care of patients with systemic lupus erythematosus SLE) have been proposed. We evaluated care according to these proposed QIs for osteoporosis and cardiovascular disease (CVD) in patients with SLE in our rheumatology practice. Methods We selected 200 patients with SLE according to American College of Rheumatology (ACR) Criteria and ≥ 2 visits to our practice in 2007–8. We performed a structured medical record review and collected demographics, SLE and past medical history, medications, laboratories and data concerning osteoporosis and CVD management. We employed univariable analyses and multivariable regression analyses to test for factors associated with care meeting the proposed QIs. Results 94% of patients were female and 64% white. Mean age was 46.3 years and mean lupus duration was 15.3 years. 29% were taking ≥ 7.5 mg prednisone per day for ≥ 3 months. The proportions of patients for whom care met the proposed QIs were: 57% for bone mineral density (BMD) testing, 62% for calcium and vitamin D supplementation, and 86% for anti-resorptive or anabolic osteoporosis medications. Only 3% had 5 cardiac risk factors assessed within the year and 26% had 4 cardiac risk factors assessed annually. Smoking, fasting lipid panels and diabetes mellitus were rarely assessed annually. Having a primary care physician (PCP) within our healthcare network increased care meeting QIs. Conclusions Care according to newly proposed QIs for osteoporosis and CVD was suboptimal in our academic center. In order to standardize and improve care of patients with SLE, we suggest specific changes to the proposed QIs.

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Background: Fatigue is a common side effect of conventional prostate cancer radiation therapy. The increased delivery precision necessitated by the high dose per fraction of stereotactic body radiation therapy (SBRT) offers the potential of reduce target volumes and hence the exposure of normal tissues to high radiation doses. Herein, we examine the level of fatigue associated with SBRT treatment. Methods: Forty patients with localized prostate cancer treated with hypofractionated SBRT, and a minimum of 12 months follow-up were included in this analysis. Self-reported fatigue and other quality of life measures were assessed at baseline and at 1, 3, 6, 9, and 12 months post-SBRT. Results: Mean levels of fatigue were elevated at 1 month post-SBRT compared to baseline values (P = 0.02). Fatigue at the 3-month follow-up and later were higher but not statistically significantly different compared to baseline. African-American patients reported higher fatigue post-SBRT than Caucasian patients. Fatigue was correlated with hormonal symptoms as measured by the Expanded Prostate Cancer Index Composite (EPIC) quality of life questionnaire, but not with urinary, bowel, or sexual symptoms. Age, co-morbidities, smoking, prostate specific antigen (PSA) levels, testosterone levels, tumor stage, and treatment variables were not associated with fatigue. Conclusion: This is the first study to investigate fatigue as a side effect of SBRT. In contrast to standard radiation therapy, results suggest SBRT-related fatigue is short-term rather than a long-term side effect of SBRT. These results also suggest post-SBRT fatigue to be a more frequent complication in African-Americans than Caucasians.