Clinical Phenotypes of Systemic Lupus Erythematosus With Regard to Age at Disease Onset

Abstract

2.2 Clinical phenotypes of systemic lupus erythematosus with regard to age at disease onset Background. Systemic lupus erythematosus (SLE) is an obscure autoimmune disease distinguished by the wide variation in its clinical and immunological characteristics, with several factors contributing to the disease heterogeneity including the influence of female sex hormones [113]. Hence SLE most frequently develops in the second through fourth decades of life, predominantly in women of childbearing age [114].However, nearly 20% of cases present during childhood, generally after puberty (juvenileonset SLE, JSLE) [115]. On the other hand, 10-20% of patients develop SLE after the age of 45-50 years (late-onset SLE, LSLE) [116].The findings about influence of age at disease onset on the clinical presentation of SLE are not always consistent across the studies. In particular, most previous studies indicate a more severe phenotype in JSLE due to higher disease activity and major organ involvement, namely renal, neuropsychiatric and hematological [117, 118]. Moreover, JSLE is associated with presence of greater damage at the time of diagnosis and is more often treated with higher doses of glucocorticoids and immunosuppressive medications, contributing to the increased morbidity and mortality when compared with adult-onset SLE (ASLE) [119]. On the other hand, LSLE patients tend to have more insidious onset of disease and less major organ involvement. However, they have a poorer prognosis due to higher frequency of comorbidities and extended exposure to cardiovascular risk factors [120][121][122].Although the age at diagnosis has a strong modulating effect on clinical presentation, disease course, response to treatment and prognosis, the findings are not always consistent across studies due to geographic and ethnic variations. Data about autoantibody profiles and inflammatory markers across age groups also remain conflicting [123][124][125][126][127].Objectives. The aim of this study was to evaluate the spectrum of clinical manifestations and autoantibody profile in patients with SLE in the central region of Ukraine regarding age at onset.