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THU0026 Greater Diagnostic Delay in Early-Onset than in Late-Onset Systemic Lupus Erythematosus - Data from Reuma.Pt/Les
  1. S. Sousa1,
  2. M.J. Gonçalves2,
  3. L. Inês3,
  4. C. Duarte3,
  5. S. Fernandes4,
  6. G. Terroso5,
  7. V.C. Romão2,
  8. M. Cerqueira6,
  9. A. Raposo6,
  10. M. Couto7,
  11. P. Nero8,
  12. T. Novoa9,
  13. P. Pinto10,
  14. J.A. Melo Gomes4,
  15. J. Canas da Silva1,
  16. L. Costa5,
  17. J. Pereira da Silva2,
  18. L. Cunha-Miranda4,
  19. J. Da Silva3,
  20. H. Canhão2,
  21. M.J. Santos1
  1. 1Rheumatology, Hospital Garcia de Orta, Almada
  2. 2Rheumatology, Hospital Santa Maria, Lisboa
  3. 3Rheumatology, Hospital da Universidade de Coimbra, Coimbra
  4. 4Rheumatology, Instituto Português de Reumatologia, Lisboa
  5. 5Rheumatology, Centro Hospitalar de São João, Porto
  6. 6Rheumatology, Hospital Conde Bertiandos, Ponte de Lima
  7. 7Rheumatology, Hospital de Viseu, Viseu
  8. 8Rheumatology, Hospital Egas Moniz, Lisboa
  9. 9Rheumatology, Hospital Divino Espírito Santo, Ponta Delgada
  10. 10Rheumatology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal

Abstract

Background Systemic lupus erythematosus (SLE) affects predominantly women of reproductive age. However, in about 15% of patients SLE begins before the age of 18 years (early-onset) and in 10-20% of patients SLE is first diagnosed after the age of 50 years (late-onset). The age at disease onset significantly impacts on clinical presentation, disease course, response to treatment and prognosis.

Objectives To compare demographic, clinical features and disease outcome between patients with early-onset and those with late-onset SLE and to determine whether patients' age affects the time interval until diagnosis.

Methods All SLE patients from the Portuguese registry Reuma.pt/LES with disease onset at age≤18 years-old or at age≥50 years-old were included. Patients' data were cross-sectionally analyzed upon records from the last visit. The differences between groups with early and late onset were determined by Student t-tests, chi-square or Fisher's exact tests.

Results 313 SLE patients were included (157 early-onset; 156 late-onset). In the early-onset group, 88% were women, mean disease duration 16.8±10.5y and mean age of diagnosis 17±5.9y. Higher education level was noted in the younger group. 81.6% of patients with late-onset SLE were women, mean disease duration 9.37±5.2y and mean age of diagnosis 60.5±7.5y. Photosensitivity, arthritis and neurological disorder were statistically more prevalent in the late-onset group. Anti-Sm positivity was observed more frequently in early-onset SLE. Co-morbidities were also more common in this age group. Disease activity evaluated using the SLEDAI-2K was higher in the early-onset (3.0±3.3 vs 2.0±2.8; p=0.01) while accumulated damage was higher in the older age group (1.0±1.3 vs 0.69±1.4; p<0.001). Diagnosis delay was significantly greater in patients with early-onset than in the late-onset group (3.1±5 vs 1.7±3 y; p=0.001).

Table 1.

Significant clinical distinctions between early and late-onset SLE patients

Conclusions Patients with late-onset SLE have more co-morbid conditions and greater accumulated damage despite shorter disease duration and lower disease activity. Age of onset has a significant impact not only on the clinical characteristics and disease outcome, but also on time until diagnosis.

Disclosure of Interest : None declared

DOI 10.1136/annrheumdis-2014-eular.5306

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