Late-onset systemic lupus erythematosus: clinical features, course, and prognosis

There are contradictory opinions if late-onset systemic lupus erythematosus (SLE) is associated with a different, more benign disease course and better prognosis than early-onset SLE. The objective of this study was to evaluate the clinical manifestations, course, treatment, and prognosis of late-on...

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Veröffentlicht in:Clinical rheumatology 2013-07, Vol.32 (7), p.1053-1058
Hauptverfasser: Tomic-Lucic, Aleksandra, Petrovic, Radmila, Radak-Perovic, Marija, Milovanovic, Dragan, Milovanovic, Jasmina, Zivanovic, Sandra, Pantovic, Suzana, Veselinovic, Mirjana
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Sprache:eng
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Zusammenfassung:There are contradictory opinions if late-onset systemic lupus erythematosus (SLE) is associated with a different, more benign disease course and better prognosis than early-onset SLE. The objective of this study was to evaluate the clinical manifestations, course, treatment, and prognosis of late-onset SLE. Patients who developed SLE after/or at the age of 50 years were considered late-onset SLE and compared to a group of randomly selected patients aged younger than 50 years at the diagnosis, matched for disease duration. Lower frequency of cutaneous manifestations ( p  = 0.01) and higher frequency of cytopenias ( p  = 0.02) were registrated at the SLE onset in the late-onset group. Atypical clinical presentation of SLE contributed to a longer delay of diagnosis in late-onset SLE patients ( p  = 0.005), who fullfiled less American College of Rheumatology criteria at the diagnosis ( p  = 0.022). Cumulative incidence of clinical manifestations showed lower frequency of cutaneous ( p  = 0.017), neuropsychiatric manifestations ( p  = 0.021), lupus nephritis ( p  = 0.006), and higher frequency of Sjogren′s syndrome ( p  = 0.025) in the late-onset group. Late-onset SLE patients received lower doses of corticosteroid ( p  = 0.006) and cyclophosphamide ( p  = 0.001) and had more cyclophosphamide-induced complications ( p  = 0.005). Higher prevalence of comorbid conditions in the late-onset group ( p  = 0.025), and higher Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index was noticed ( p  = 0.018). Despite the less major organ involvement and more benign course of disease, late-onset SLE has poorer prognosis, because of the higher frequency of comorbid conditions and higher organ damage, due to the aging and longer exposition to a classical vascular risk factors.
ISSN:0770-3198
1434-9949
DOI:10.1007/s10067-013-2238-y