Cluster Analysis of Socioeconomic and Environmental Determinants Modifying Activity, Chronicity and Clinical Manifestations of Systemic Lupus Erythematosus in the GLADEL 2.0 Cohort

Marco Martinez¹, Karen Roberts², Rosana Quintana³, Marina Scolnik⁴, Carmen Funes Soaje⁵, Paula Alba⁶, Veronica Saurit⁷, Mercedes Garcia⁸, GUILLERMO ARIEL BERBOTTO⁹, Inés Verónica Bellomio¹⁰, Mario Eduardo Kerzberg¹¹, Graciela Noemi Gomez¹², Cecilia Pisoni¹³, Vicente Juarez¹⁴, Ana Malvar¹⁵, Antonio Da Silva¹⁶, ODIRLEI MONTICIELO¹⁷, Henrique Mariz¹⁸, Francinne Ribeiro¹⁹, Eduardo Borba²⁰, Eloisa Bonfa²⁰, Edgard dos Reis-Neto²¹, Iris Guerra Herrera²², Maria Loreto Massardo²³, Gustavo Aroca-Martínez²⁴, Lorena Gómez Escorcia²⁵, Carlos Alberto Cañas²⁶, Gerardo Quintana-Lopez²⁷, Carlos Toro-Gutierrez²⁸, Mario Moreno Alvarez²⁹, MIGUEL SAAVEDRA³⁰, Margarita Portela Hernández³¹, Hilda Fragoso-Loyo³², Luis H Silveira³³, Ignacio García-De la Torre³⁴, Carlos Abud-Mendoza³⁵, Jorge Antonio Esquivel Valerio³⁶, Maria Isabel Acosta³⁷, Astrid Paats³⁸, Claudia S. Mora-Trujillo³⁹, Manuel Ugarte-Gil⁴⁰, Armando Calvo⁴¹, Roberto Muñoz-Louis⁴², Martin Rebella⁴³, Alvaro Danza⁴⁴, José Gomez-Puerta⁴⁵, Federico Zazzetti⁴⁶, Ashley Orillion⁴⁷, Guillermo Pons-Estel³ and Ingris del Pilar Pelaez Ballestas⁴⁸, ¹HGSZ No ⁹, Instituto Mexicano del Seguro Social, San Luis Potosí, México, Rioverde, Mexico, ²Instituto de Investigación, Rosario, Argentina, Wyomissing, PA, ³Centro Regional de Enfermedades Autoinmunes y Reumáticas, GO-CREAR, Rosario, Argentina, Rosario, Argentina, ⁴Hospital Italiano de Buenos Aires, Argentina, Buenos Aires, Argentina, ⁵Hospital Italiano de Córdoba, Córdoba, Argentina, Cordoba, Argentina, ⁶Hospital Córdoba y Sanatorio Allende, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina, Cordoba, Argentina, ⁷Hospital Privado Universitario de Cordoba, Córdoba, Argentina, Córdoba, Argentina, ⁸Hospital Interzonal General de Agudos “General San Martín” de la plata, La Plata, Argentina, ⁹Sanatorio Británico, Rosario, Argentina, ROSARIO, Argentina, ¹⁰Hospital Padilla, Tucumán, Argentina, San Miguel de Tucumán, Argentina, ¹¹Hospital J.M Ramos Mejía, Buenos Aires, Argentina, CABA, Argentina, ¹²Instituto de Investigaciones Médicas Dr. Alfredo Lanari, Don Torcuato, Argentina, ¹³CEMIC Centro de Educación Médica e Investigaciones Clínicas ‘‘Norberto Quirno”, Buenos Aires, Argentina, Ciudad Autonoma Buenos Aires, Argentina, ¹⁴Hospital Señor del Milagro Salta, Salta, Argentina, Salta, Argentina, ¹⁵Organización Médica de Investigación, Buenos Aires, Argentina, ¹⁶Hospital das Clinicas da Universidade Federal de Goias, Goias, Brazil, Holzkirchen, Germany, ¹⁷Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil, PORTO ALEGRE, Rio Grande do Sul, Brazil, ¹⁸Universidad Federal de Pernambuco, Pernambuco, Brazil, Pernambuco, Brazil, ¹⁹Hospital Universitário Pedro Ernesto - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil, Rio De Janeiro, Rio de Janeiro, Brazil, ²⁰Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, São Paulo, Brazil, ²¹Escola Paulista de Medicina / Universidade federal de São Paulo (EPM / Unifesp), São Paulo, Brazil, São Paulo, Brazil, ²²Hospital del Salvador Santiago de Chile, Santiago, Chile, santiago, Chile, ²³Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile, Santiago, Chile, ²⁴Clínica de la Costa y Universidad Simón Bolívar, Barranquilla, Colombia, barranquilla, Colombia, ²⁵Clínica de la Costa y Universidad Simón Bolívar Barranquilla, Barranquilla, Colombia, Barranquilla, Colombia, ²⁶Fundación Valle del Lili, Universidad Icesi, Cali, Colombia, Cali, Colombia, ²⁷Facultad de Medicina, Universidad Nacional de Colombia; Hospital Universitario Fundación Santa Fe de Bogotá; Hospital Universitario Nacional de Colombia, Bogotá, Colombia, Bogota, Colombia, ²⁸Pontificia Universidad Javeriana de Cali, Cali, Colombia, Cali, Colombia, ²⁹Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador, Guayaquil, Ecuador, ³⁰Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico, MEXICO, Mexico, ³¹Hospital de Especialidades del Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico, Mexico City, Mexico, ³²Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Mexico City, Mexico, ³³Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico, Mexico City, Mexico, ³⁴Centro de Estudios de Investigación Básica y Clínica, S.C., Guadalajara, Mexico, Guadalajara, Jalisco, Mexico, ³⁵Facultad de Medicina de la Universidad Autónoma de San Luis Potosí y Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosí, Mexico, San Luis Potosí, Mexico, ³⁶Universidad Autónoma de Nuevo León, Rheumatology Service, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Nuevo León, México., MONTERREY, Mexico, ³⁷Facultad de Ciencias Medicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay, Asuncion, Paraguay, ³⁸Facultad de Ciencias Medicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay, Asunción, Paraguay, ³⁹Hospital Nacional Edgardo Rebagliati Martins-EsSalud, Lima, Peru, Lima, Peru, ⁴⁰Universidad Cientifica del Sur, Lima, Peru, ⁴¹Hospital Nacional Cayetano Heredia Universidad Peruana Cayetano Heredia, Lima, Peru, Jesús María, Peru, ⁴²Hospital Docente Padre Billini, Santo Domingo, Distrito Nacional, Dominican Republic, ⁴³Hospital de Clínicas, Facultad de Medicina, UDELAR, Montevideo, Uruguay, Montevideo, Uruguay, ⁴⁴Médica Uruguaya, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay, Montevideo, Uruguay, ⁴⁵Rheumatology Department, Hospital Clinic, Barcelona, Spain, Barcelona, Spain, ⁴⁶Johnson & Johnson, Horsham, PA, USA, Ambler, PA, ⁴⁷Johnson & Johnson, Spring House, PA, USA, Spring House, PA, ⁴⁸Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico, Mexico, Mexico

Meeting: ACR Convergence 2025

Keywords: socioeconomic factors, Systemic lupus erythematosus (SLE)

Session Information

Date: Sunday, October 26, 2025

Title: (0593–0640) Systemic Lupus Erythematosus – Diagnosis, Manifestations, & Outcomes Poster I

Session Type: Poster Session A

Session Time: 10:30AM-12:30PM

Background/Purpose: Systemic lupus erythematosus (SLE) is a complex autoimmune disease with heterogeneous clinical manifestations. Evidence from high-income countries suggests that socioeconomic status (SES) and environmental factors influence SLE outcomes, yet data from Latin America remain limited. The objective of this research was to evaluate, across three levels (individual, regional, and national), whether socioeconomic and environmental factors impact the clinical presentation of SLE in the GLADEL 2.0 cohort.

Methods: We analyzed data from 1,083 patients with SLE enrolled in the GLADEL 2.0 cohort across 10 Latin American countries. All patients fulfilled the 1982/1997 American College of Rheumatology (ACR) or 2012 Systemic Lupus International Cooperating Clinics (SLICC) classification criteria. Clinical outcomes were disease activity (SLEDAI-2K), organ involvement (renal, hematologic, cutaneous, musculoskeletal), and organ damage (SLICC/ACR damage index; SDI). Variables were structured into three levels: Level 1 (individual), Level 2 (state/province), and Level 3 (national). Multilevel analyses included sociodemographic variables, environmental exposure to air pollutants (PM2.5, PM10, NO2), and contextual indicators (income, unemployment, distribution of income or wealth through the Gini index, CO2 emissions). Statistical analysis included cluster analysis (Ward’s method) and principal component analysis (PCA).

Results: Five clusters emerged based on socioeconomic and environmental determinants. Cluster two (urban, high-income, low inequality) exhibited low damage (SDI [mean ± SD] 0.66 ± 0.9) and high disease activity (SLEDAI [mean ± SD] 13.0 ± 9.2). Conversely, Cluster four (middle-low SES, high inequality, high NO2 exposure) demonstrated high disease impact (SDI [mean ± SD] 1.06 ± 1.4) and greatest work productivity loss (36.1%). Cluster three (low-income, low pollution) presented the highest accumulated damage (mean SDI [mean ± SD] 1.73 ± 1.95). Environmental exposures varied significantly; Cluster five showed the highest CO2 emissions and solar irradiance, while Cluster three had the lowest environmental burden. PCA showed that clinical manifestations, disease activity and chronicity were different across clusters. The figure highlights the separation of the characteristics according to the three principal components.

Conclusion: Socioeconomic and environmental factors at individual, regional, and national levels influence the cumulative clinical manifestations and patient-reported outcomes in SLE. Our findings underscore the role of social vulnerability and environmental stressors as potential modifiers of SLE phenotype in Latin America, highlighting the need for context-sensitive interventions and policies to mitigate health inequities.

Figure. Three-dimensional representation of the first three principal components, showing the five clusters of SLE patients derived from socioeconomic and environmental variables

Disclosures: M. Martinez: None; K. Roberts: None; R. Quintana: None; M. Scolnik: AstraZeneca, 2, 5, 6, GSK, 1, 5, 6, Janssen, 1, 5, 6, Pfizer, 1, 5, 6, Roche, 1, 5, 6; C. Funes Soaje: None; P. Alba: None; V. Saurit: None; M. Garcia: None; G. BERBOTTO: None; I. Bellomio: None; M. Kerzberg: None; G. Gomez: None; C. Pisoni: None; V. Juarez: None; A. Malvar: Bristol-Myers Squibb(BMS), 2, F. Hoffman-La Roche Ltd/Genentech, Inc., 2, GlaxoSmithKline (GSK), 2, Kezar, 2, Novartis, 2, Pfizer, 2; A. Da Silva: None; O. MONTICIELO: None; H. Mariz: None; F. Ribeiro: None; E. Borba: Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (303378/2022-0), 5, GlaxoSmithKlein(GSK), 5; E. Bonfa: Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) #305242/2019-9, 5, Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP) (2022/12925-8), 5, GlaxoSmithKlein(GSK), 5; E. dos Reis-Neto: None; I. Guerra Herrera: None; M. Massardo: None; G. Aroca-Martínez: None; L. Gómez Escorcia: None; C. Cañas: None; G. Quintana-Lopez: None; C. Toro-Gutierrez: None; M. Moreno Alvarez: None; M. SAAVEDRA: None; M. Portela Hernández: None; H. Fragoso-Loyo: None; L. Silveira: None; I. García-De la Torre: None; C. Abud-Mendoza: None; J. Esquivel Valerio: None; M. Acosta: None; A. Paats: None; C. Mora-Trujillo: None; M. Ugarte-Gil: AstraZeneca, 1, 6, Ferrer, 1, GlaxoSmithKlein(GSK), 6, Janssen, 5, technofarma, 1; A. Calvo: None; R. Muñoz-Louis: None; M. Rebella: None; A. Danza: None; J. Gomez-Puerta: AbbVie/Abbott, 6, AstraZeneca, 6, GlaxoSmithKlein(GSK), 6, Pfizer, 6; F. Zazzetti: Johnson & Johnson, 3, 11; A. Orillion: Johnson & Johnson, 3, 11; G. Pons-Estel: AstraZeneca, 1, 6, GlaxoSmithKlein(GSK), 1, 6, Janssen, 1, 6; I. Pelaez Ballestas: None.

To cite this abstract in AMA style:

Martinez M, Roberts K, Quintana R, Scolnik M, Funes Soaje C, Alba P, Saurit V, Garcia M, BERBOTTO G, Bellomio I, Kerzberg M, Gomez G, Pisoni C, Juarez V, Malvar A, Da Silva A, MONTICIELO O, Mariz H, Ribeiro F, Borba E, Bonfa E, dos Reis-Neto E, Guerra Herrera I, Massardo M, Aroca-Martínez G, Gómez Escorcia L, Cañas C, Quintana-Lopez G, Toro-Gutierrez C, Moreno Alvarez M, SAAVEDRA M, Portela Hernández M, Fragoso-Loyo H, Silveira L, García-De la Torre I, Abud-Mendoza C, Esquivel Valerio J, Acosta M, Paats A, Mora-Trujillo C, Ugarte-Gil M, Calvo A, Muñoz-Louis R, Rebella M, Danza A, Gomez-Puerta J, Zazzetti F, Orillion A, Pons-Estel G, Pelaez Ballestas I. Cluster Analysis of Socioeconomic and Environmental Determinants Modifying Activity, Chronicity and Clinical Manifestations of Systemic Lupus Erythematosus in the GLADEL 2.0 Cohort [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/cluster-analysis-of-socioeconomic-and-environmental-determinants-modifying-activity-chronicity-and-clinical-manifestations-of-systemic-lupus-erythematosus-in-the-gladel-2-0-cohort/. Accessed .

« Back to ACR Convergence 2025

ACR Meeting Abstracts - https://acrabstracts.org/abstract/cluster-analysis-of-socioeconomic-and-environmental-determinants-modifying-activity-chronicity-and-clinical-manifestations-of-systemic-lupus-erythematosus-in-the-gladel-2-0-cohort/