Nearly all studies examining the epidemiology of SLE have observed higher morbidity and mortality for black patients. Lower socioeconomic status is believed to explain this discrepancy, in part. Lower socioeconomic status is associated with factors such as diminished access to health care, inadequate knowledge of disease, less availability of social supports, etc. Many of these are amendable to public health and social policy strategies to improve health status in high-risk populations. Advances during the last decade in both reduction of time between first symptom and time of diagnosis as well as in treatment of severe SLE and finally the longer term trend toward better survival for patients with SLE have increased the relative importance of long-term management, particularly in vulnerable underserved populations. A long-term randomized controlled educational intervention is proposed. The study will determine the educational and compliance deficits of patients with SLE; define the minimal education effort necessary to overcome these deficits at various stages of the disease; and determine the longest interval at which the intervention must be repeated in order to maintain an effect upon compliance and intermediate clinical outcomes including blood pressure control, functional status, lupus activity and cumulative damage due to SLE.
