Late-onset versus early-onset systemic lupus: characteristics and outcome in a national multicentre register (RELESSER)

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.

Impact of systemic lupus erythematosus disease activity, hydroxychloroquine and NSAID on the risk of subsequent organ system damage and death: analysis in a single US medical centre

“…This analysis described the impact of disease activity during a 12-month period on the subsequent risk of death or organ system damage in a large, prospective cohort of racially diverse patients with SLE. This study included a large proportion of patients of Black African Ancestry (39.4%), which contrasts with previous Spanish studies (eg, RELESSER cohort) [24][25][26] where the majority of Immunology and inflammation patients were white (>90%), and Latin American studies (eg, GLADEL), [27][28][29] which had lower percentages of African-Latin American patients (<13%). In this cohort of patients with SLE and mild-to-moderate disease activity at cohort entry, adjusted mean SELENA-SLEDAI measured during a prior 12-month period (corresponding to the length of a typical Phase III trial) significantly impacted the risk of renal and cardiovascular damage accrual (SDI≥1) and risk of death in the follow-up period.…”

Case Report: A Rare Case of Elderly-Onset Adult-Onset Still’s Disease in a Patient With Systemic Lupus Erythematosus

“…Our patient developed SLE at the age of 77 prior to the onset of AOSD. Late-onset SLE that develops after the age of 50 has been increasingly reported, affecting 2-20% of all patients with SLE ( 17 ). The onset of late-onset SLE is insidious, and uncommon clinical manifestations may lead to delayed diagnosis ( 17 – 19 ).…”

“…Late-onset SLE that develops after the age of 50 has been increasingly reported, affecting 2-20% of all patients with SLE ( 17 ). The onset of late-onset SLE is insidious, and uncommon clinical manifestations may lead to delayed diagnosis ( 17 – 19 ). Late-onset SLE has been reported to have less frequent skin manifestations, arthritis, and nephritis than early onset SLE ( 17 – 19 ).…”

“…The onset of late-onset SLE is insidious, and uncommon clinical manifestations may lead to delayed diagnosis ( 17 – 19 ). Late-onset SLE has been reported to have less frequent skin manifestations, arthritis, and nephritis than early onset SLE ( 17 – 19 ). In our patient, there were no symptoms at the onset of SLE, including skin manifestations or arthritis, and no laboratory abnormalities suggestive of nephritis.…”

Commentary: ‘Case Report: A Rare Case of Elderly-Onset Adult Onset Still’s Disease in a Patient With Systemic Lupus Erythematous’

“…We were challenged firstly by the co-occurrence of two rare diseases and secondly by their very late onset. Occurrence of SLE after 75 years of age is a rare condition, this disease being mainly affecting women of reproductive age between the second and fourth decades of life with late onset (>50 years old) in only 5% to 20% ( 1 , 2 ). In the past, SLE was reported as part of the autoimmune manifestation of myelodysplastic syndrome ( 3 – 5 ).…”