Late-onset systemic lupus erythematosus: characteristics and outcome in comparison to juvenile- and adult-onset patients—a multicenter retrospective cohort

Medhat, Basma M.; Behiry, Mervat Essam; Sobhy, Nesreen; Farag, Yomna; Marzouk, Huda; Mostafa, Noha; Khalifa, Iman; Elkhalifa, Marwa; Eissa, Basma M.; Hassan, Ekram M.

doi:10.1007/s10067-019-04776-y

Cited by 25 publications

(15 citation statements)

References 34 publications

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“…In their review, Boddaert et al [9] included 23 studies examining neuropsychiatric manifestations in late-onset SLE with a different age cut-off point (45-60 years) and showed that NPSLE occurred less frequently in late-onset SLE compared with early onset (15.3% vs 20.2%; p = 0.025). More recent studies, from the last decade, are in agreement with these findings [11,27,[29][30][31][32], though other reports show no differences in the prevalence of NPSLE in late-onset SLE compared to early-onset SLE [10,[33][34][35][36][37][38]. One study found more frequent NPSLE events in late-onset SLE compared to patients with early-onset SLE [39].…”

Section: Epidemiology Of Late-onset Npslesupporting

confidence: 68%

Neuropsychiatric Systemic Lupus Erythematosus in Older Adults: Diagnosis and Management

2021

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Systemic lupus erythematosus (SLE) is a multisystem chronic autoimmune disease with variable clinical manifestations. Neuropsychiatric systemic lupus erythematosus (NPSLE) includes the neurologic syndromes of the central, peripheral and autonomic nervous system and the psychiatric syndromes observed in patients with SLE. Neuropsychiatric systemic lupus erythematosus events may present as an initial manifestation of SLE or may be diagnosed later in the course of the disease. Older adults with NPLSE include those who are ageing with known SLE and those with late-onset SLE. The diagnosis of NPSLE across the lifespan continues to be hampered by the lack of sensitive and specific laboratory and imaging biomarkers. In this review, we discuss the particular complexity of NPSLE diagnosis and management in older adults. We first discuss the epidemiology of late-onset NPSLE, then review principles of diagnosis of NPSLE, highlighting issues that are pertinent to older adults and that make diagnosis and attribution more challenging, such as atypical disease presentation, higher medical comorbidity, and differences in neuroimaging and autoantibody investigations. We also discuss clinical issues that are of particular relevance to older adults that have a high degree of overlap with SLE, including drug-induced lupus, cerebrovascular disease and neurocognitive disorders. Finally, we review the management of NPSLE, mainly moderate to high-dose glucocorticoids and immunosuppressants, again highlighting considerations for older adults, such as increased medication (especially glucocorticoids) adverse effects, ageing-related pharmacokinetic changes that can affect SLE medication management, medication dosing and attention to medical comorbidities affecting brain health.

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Section: Epidemiology Of Late-onset Npslesupporting

confidence: 68%

Neuropsychiatric Systemic Lupus Erythematosus in Older Adults: Diagnosis and Management

2021

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“…Indeed, cSLE patients had a higher prevalence of initial and cumulative multiorgan system involvement, such as nephritis, neuropsychiatric, hematological, and macrophage activation syndrome, than adult-onset SLE patients [ 13 , 25 – 35 ]. In contrast, late-onset SLE (> 50 years) patients had the lowest prevalence of constitutional and mucocutaneous manifestations, serositis, and hypocomplementemia compared with cSLE and adult-onset SLE [ 36 ]. Children and adolescent patients use the same immunosuppressive agents as adult SLE patients, and generally require more aggressive treatment to achieve disease control than adult SLE populations [ 1 , 2 , 25 , 28 – 31 ].…”

Section: Introductionmentioning

confidence: 99%

An Update on the Management of Childhood-Onset Systemic Lupus Erythematosus

et al. 2021

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Childhood-onset systemic lupus erythematosus (cSLE) is a prototype of a multisystemic, inflammatory, heterogeneous autoimmune condition. This disease is characterized by simultaneous or sequential organ and system involvement, with unpredictable flare and high levels of morbidity and mortality. Racial/ethnic background, socioeconomic status, cost of medications, difficulty accessing health care, and poor adherence seem to impact lupus outcomes and treatment response. In this article, the management of cSLE patients is updated. Regarding pathogenesis, a number of potential targets for drugs have been studied. However, most treatments in pediatric patients are off-label drugs with recommendations based on inadequately powered studies, therapeutic consensus guidelines, or case series. Management practices for cSLE patients include evaluations of disease activity and cumulative damage scores, routine non-live vaccinations, physical activity, and addressing mental health issues. Antimalarials and glucocorticoids are still the most common drugs used to treat cSLE, and hydroxychloroquine is recommended for nearly all cSLE patients. Disease-modifying antirheumatic drugs (DMARDs) should be standardized for each patient, based on disease flare and cSLE severity. Mycophenolate mofetil or intravenous cyclophosphamide is suggested as induction therapy for lupus nephritis classes III and IV. Calcineurin inhibitors (cyclosporine, tacrolimus, voclosporin) appear to be another good option for cSLE patients with lupus nephritis. Regarding B-cell-targeting biologic agents, rituximab may be used for refractory lupus nephritis patients in combination with another DMARD, and belimumab was recently approved by the US Food and Drug Administration for cSLE treatment in children aged > 5 years. New therapies targeting CD20, such as atacicept and telitacicept, seem to be promising drugs for SLE patients. Anti-interferon therapies (sifalimumab and anifrolumab) have shown beneficial results in phase II randomized control trials in adult SLE patients, as have some Janus kinase inhibitors, and these could be alternative treatments for pediatric patients with severe interferon-mediated inflammatory disease in the future. In addition, strict control of proteinuria and blood pressure is required in cSLE, especially with angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use.

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“…One prospective study in Toronto found that late-onset SLE where patients were diagnosed at age older than 50 years had more cardiovascular, renal, and ocular damage, which may have been due to the aging process ( Aljohani et al, 2017 ). Although patients with late-onset SLE had the lowest incidence of major organ involvement, the highest prevalence of comorbidities and positive anti-dsDNA antibodies was found; this finding makes late-onset SLE more complicated ( Medhat et al, 2020 ). Late-onset SLE patients often have insidious onset and lower disease activities but usually have poor outcomes, especially in men ( Pons-Estel et al, 2010 ).…”

Section: Discussionmentioning

confidence: 99%

Mycoplasma pneumonia Infection Is Associated With an Increased Risk of Systemic Lupus Erythematosus: A Nationwide, Retrospective Cohort Study

Chu

Hung

et al. 2022

Front. Microbiol.

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BackgroundInfections may play a role in the development of systemic lupus erythematosus (SLE).ObjectiveTo assess the link between Mycoplasma pneumonia (M. pneumonia) infection and the incidence of SLE.MethodWe conducted a retrospective cohort study, which identified 116,043 hospitalized patients with M. pneumoniae between 2000 and 2012 from the Taiwan National Health Insurance Research Database and compared them with 447,839 matched inpatients who had never been diagnosed with M. pneumonia infection (at a 1:4 ratio, matched by age, gender, and index year). Their comparative risk of developing SLE was evaluated. The follow-up period was defined as the time from the initial diagnosis of M. pneumonia infection to the date of SLE diagnosis, or December 31, 2013. The incidence rates of SLE were assessed in people with and without M. pneumoniae infection. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs), with the uninfected group used as the reference.ResultsThe adjusted HR of SLE for the M. pneumoniae group was 2.97 with 95% CI = 2.18–4.05 compared with the uninfected group. The risk was most significantly higher within 0.5 years after the M. pneumoniae infection with an adjusted HR of 6.18 (95% CI = 3.82–9.97, p < 0.01). The adjusted HR for SLE from 0.5 to 2 years and from 2 to 5 years after M. pneumoniae infection was 1.59 (95% CI = 0.70–3.59, p = 0.27) and 2.42 (95% CI = 1.22–4.81, p = 0.01), respectively.ConclusionThe incidence of SLE was significantly higher in subjects infected with M. pneumoniae.

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Late-onset systemic lupus erythematosus: characteristics and outcome in comparison to juvenile- and adult-onset patients—a multicenter retrospective cohort

Cited by 25 publications

References 34 publications

Neuropsychiatric Systemic Lupus Erythematosus in Older Adults: Diagnosis and Management

Neuropsychiatric Systemic Lupus Erythematosus in Older Adults: Diagnosis and Management

An Update on the Management of Childhood-Onset Systemic Lupus Erythematosus

Mycoplasma pneumonia Infection Is Associated With an Increased Risk of Systemic Lupus Erythematosus: A Nationwide, Retrospective Cohort Study

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