Neonatal Lupus Erythematosus: A Review of the Racial Differences and Similarities in Clinical, Serological and Immunogenetic Features of Japanese versus Caucasian Patients

Abstract

There has been tremendous interest in neonatal lupus erythematosus (NLE) since the reports of anti-Ro/SSA antibodies as a diagnostic marker. Recent studies, including ours, have revealed racial differences as well as similarities in the clinical features and immunogenetic backgrounds of Japanese and Caucasian patients with NLE. The frequency of photosensitivity and subacute cutaneous LE lesions is not high in Japanese infants with NLE, which is in sharp contrast to their Caucasian American counterparts. The majority of Japanese infants with NLE develop annular, erythematous or edematous lesions which have also been reported in association with Sjögren's syndrome. The frequency of isolated congenital heart block (CHB) is about 50% in Japanese anti-Ro/SSA positive neonatal lupus infants; this is similar to the frequency among Caucasians. The HLA-DR3 phenotype, which is found in the great majority of Caucasian mothers of NLE infants, is absent in Japanese mothers. Finally, both Japanese and Caucasian children with CHB are often identical to their mothers in their alleles of HLA-DRB1, DQA1 and DQB1 loci.

Neonatal lupus erythematosus: a review of 123 cases in China

“…In a study of 193 NLE cases in Japan and a study of 17 NLE cases in Thailand, skin lesions were found in 85.5% and 70.6% of neonates, respectively . Thus, cutaneous manifestation appears to be extremely common in China, even compared to other Asian countries, suggesting that there might be ethnic or geographic differences with the symptoms of NLE, although currently only a few studies have explored this possibility . Furukawa et al .…”

Neonatal Lupus Erythematosus

“…The presence of certain major histocompatibility complexes such as human leukocyte antigen B8 and human leukocyte antigen DR3 in the mother predisposes the infant to NLE and congenital heart block [17, 18]. Although there is no apparent racial predilection, disparity in outcomes between minorities and whites has been observed [5, 10, 16, 18–20]. Like many autoimmune diseases, reports from the Research Registry for Neonatal Lupus/US indicate that the female-to-male ratio is approximately 2 : 1 with cutaneous NLE, but the gender distribution for cardiac disease is approximately equal [21, 22].…”

Profile of lupus autoantibodies found in Asia

“…Anti‐Ro/SSA antibodies in Japanese mothers were also found to cause neonatal lupus syndrome. Congenital heart block was found in 50% of these complicated newborns, similar in frequency to Caucasians 26 …”