A meta-analysis of the clinical manifestations of older-onset systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) with onset in later life has been reported to have a clinical presentation different from that in younger individuals; however, the disease manifestations typical of older-onset SLE patients are known to vary widely among published studies. Meta-analysis is a statistical process capable of quantitatively combining the results of these reports. This meta-analysis examines the methodologic features of studies investigating age-associated manifestations of SLE, and pools estimates of association between clinical features of SLE and age across these studies. Serositis, interstitial pulmonary disease, anti-La antibodies, and Sjögren's syndrome were most strongly and consistently associated with older-onset SLE, while alopecia, Raynaud's phenomenon, fever, lymphadenopathy, hypocomplementemia, and neuropsychiatric illness were present less frequently in this group. The extent to which information bias, selection bias, and uncontrolled confounding effects potentially influence these results is discussed. The available information in the literature does not describe the spectrum of clinical manifestations of SLE in the elderly sufficiently to allow its categorization as a distinct entity.