Background Systemic lupus erythematosus (SLE) is an autoimmune, immune-complex, multi-system, chronic inflammatory disease of the connective tissue. Late onset SLE (LSLE) represents a specific sub-group of the disorder, beginning after 50 years of age.
Objectives The objective of this study is to evaluate the association of clinical features and prognosis with age at disease onset in patients (pts) with SLE. This article discusses the prevalence, clinical course, serological features, prognosis and treatment of LSLE.
Methods Medical records of 301 SLE consecutive pts were reviewed and classified into three groups according to their ages at disease presentation. Sociodemographic, clinical and laboratory data, concomitant diseases were found at the time of diagnosis of SLE. Categorical data were analyzed by chi-square test and potentially associated factors were tested by multinomial logistic regression.
Results Among the pts studied, 33 (10,96%) were juvenile (J) onset (≤18 years), 236 (78,41%) were adult (A) onset (>18 and ≤50 years) and 32 (10,63%) were LSLE (>50 years). The incidence of LSLE was significantly higher in women than in men (p<0,001), but the predominance of women among LSLE (4:1) was reduced when compared with that observed in JSLE or ASLE. JSLE were more likely to be untreated before admission (p<0,001) and have mucocutaneous manifestations (p<0,001), but musculoskeletal symptoms (p<0,05) and leukopenia (p<0,05) were less frequent, while comorbidities were much higher in pts with LSLE (p<0,001). Arthritis, fever, serositis, sicca symptoms, Raynaud's syndrome, Sjögren's syndrome, lung disease, neuropsychiatric symptoms, hemolytic anemia and thrombosis were more frequently found in LSLE, while malar rash, discoid lupus, photosensitivity, vasculitis and glomerulonephritis are less common in LSLE compared with JSLE or ASLE. Most LSLE pts have a positive anti-nuclear antibody test, but anti-double-stranded DNA, anti-C1q antibodies, anti-ribosomal antibodies, hypocomplementaemia and anti-Sm antibodies were found more frequently in JSLE and less frequently in than ASLE or LSLE. Rheumatoid factor, anti-Ro/SS A and anti-La/SSB are more often positive in LSLE.
The diagnosis of LSLE is often delayed and treatment is determined by the presence of concomitant diseases, NSAID's, antimalarials or low doses of glucocorticoids are used for the less severe forms. Immunosuppressives and higher doses of glucocorticoids are the treatments of choice for more severe organ involvements and complications.
The probability of survival was reduced in LSLE patients. With respect to this, the 10-year and 15-year survival probability were 78,2% and 58,4% in the LSLE group and 94,7% and 90,4% in patients with JSLE, respectively. Infections are the main cause of death in LSLE pts.
Conclusions Our results indicate that SLE pts present with different clinical and serological manifestations according to age at disease onset. LSLE has specific features with misleading signs and symptoms, but its clinical course seems milder compared with that in younger pts. Considering that the LSLE pts had simultaneously easily controllable diseases and high incidence of comorbidities, a different treatment strategy from JSLE pts should be considered. Our data support the claim of a reduced probability of survival in the older age-group of SLE patients.
Disclosure of Interest None declared
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