Anne Riveros Frutos1,2, Susana Holgado1, Arantza Sanvisens Bergé3, Irma Casas4, Alejandro Olivé1, Francisco J López-Longo5, Jaime Calvo-Alén6, María Galindo7, Antonio Fernández-Nebro8, José M Pego-Reigosa9, Iñigo Rúa-Figueroa10. 1. Rheumatology Department, Germans Trias i Pujol University Hospital, Badalona, Spain. 2. Medicine Department, Universidad Autonoma de Barcelona, Barcelona, Spain. 3. Internal Medicine Department, Institut de Recerca Germans Trias i Pujol (IGTP), Spain. 4. Preventive Department, Germans Trias i Pujol University Hospital, Badalona, Spain. 5. Rheumatology Department, Gregorio Marañón University Hospital, Madrid, Spain. 6. Rheumatology Department, Araba University Hospital, Vitoria, Spain. 7. Rheumatology Department, Doce de Octubre University Hospital, Madrid, Spain. 8. Rheumatology Department, Carlos Haya University Hospital, Málaga, Spain. 9. Rheumatology Department, University Hospital Complex, Instituto de Investigación Biomédica de Vigo (IBIV), Vigo, Spain. 10. Rheumatology Department, Doctor Negrín University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain.
Abstract
OBJECTIVE: The aim of the present study was to describe the demographic, clinical and immunological characteristics of patients with late-onset (≥50 years) SLE vs patients with early-onset SLE (<50 years). METHODS: We performed a cross-sectional retrospective study of 3619 patients from the RELESSER database (National Register of Patients with Systemic Lupus Erythematosus of the Spanish Society of Rheumatology). RESULTS: A total of 565 patients (15.6%) were classified as late-onset SLE and 3054 (84.4%) as early-onset SLE. The male-to-female ratio was 5:1. Mean (s.d.) age at diagnosis in the late-onset group was 57.4 (10.4) years. At diagnosis, patients with late-onset SLE had more comorbid conditions than patients with early-onset SLE; the most frequent was cardiovascular disease (P <0.005). Furthermore, diagnostic delay was longer in patients with late-onset SLE [45.3 (3.1) vs 28.1 (1.0); P <0.001]. Almost all patients with late-onset SLE (98.7%) were Caucasian. Compared with early-onset SLE and after adjustment for time since diagnosis, patients with late-onset SLE more frequently had serositis, major depression, thrombotic events, cardiac involvement and positive lupus anticoagulant values. They were also less frequently prescribed immunosuppressive agents. Mortality was greater in late-onset SLE (14.3% vs 4.7%; P <0.001). CONCLUSION: Late-onset SLE is insidious, with unusual clinical manifestations that can lead to diagnostic errors. Clinical course is generally indolent. Compared with early-onset disease, activity is generally reduced and immunosuppressants are less commonly used. Long-term prospective studies are necessary to determine whether the causes of death are associated with clinical course or with age-associated comorbidities in this population.
OBJECTIVE: The aim of the present study was to describe the demographic, clinical and immunological characteristics of patients with late-onset (≥50 years) SLE vs patients with early-onset SLE (<50 years). METHODS: We performed a cross-sectional retrospective study of 3619 patients from the RELESSER database (National Register of Patients with Systemic Lupus Erythematosus of the Spanish Society of Rheumatology). RESULTS: A total of 565 patients (15.6%) were classified as late-onset SLE and 3054 (84.4%) as early-onset SLE. The male-to-female ratio was 5:1. Mean (s.d.) age at diagnosis in the late-onset group was 57.4 (10.4) years. At diagnosis, patients with late-onset SLE had more comorbid conditions than patients with early-onset SLE; the most frequent was cardiovascular disease (P <0.005). Furthermore, diagnostic delay was longer in patients with late-onset SLE [45.3 (3.1) vs 28.1 (1.0); P <0.001]. Almost all patients with late-onset SLE (98.7%) were Caucasian. Compared with early-onset SLE and after adjustment for time since diagnosis, patients with late-onset SLE more frequently had serositis, major depression, thrombotic events, cardiac involvement and positive lupus anticoagulant values. They were also less frequently prescribed immunosuppressive agents. Mortality was greater in late-onset SLE (14.3% vs 4.7%; P <0.001). CONCLUSION: Late-onset SLE is insidious, with unusual clinical manifestations that can lead to diagnostic errors. Clinical course is generally indolent. Compared with early-onset disease, activity is generally reduced and immunosuppressants are less commonly used. Long-term prospective studies are necessary to determine whether the causes of death are associated with clinical course or with age-associated comorbidities in this population.
Authors: Melissa E Munroe; Kendra A Young; Joel M Guthridge; Diane L Kamen; Gary S Gilkeson; Michael H Weisman; Mariko L Ishimori; Daniel J Wallace; David R Karp; John B Harley; Jill M Norris; Judith A James Journal: Front Immunol Date: 2022-06-03 Impact factor: 8.786