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.

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The effects of co-administration of dry olive leaf extract (DOLE) with standard methotrexate (MTX) therapy on the parameters of cell damage and inflammation in patients with early and long-term rheumatoid arthritis (RA) were evaluated at baseline, 3 and 6 weeks. Patients were assigned to groups: the early phase RA group on MTX monotherapy (E MTX), and the two RA groups that received co-treatment with DOLE and MTX: early (E MTX + DOLE) and long-term phase patients (L-t MTX+ DOLE). Baseline values indicated increased parameters of cell damage and disruption of redox balance in all groups. After three weeks the E MTX + DOLE group maintained high catalase activity, exhibited decrease of lipid peroxidation and protein damage indicators-thiols and nitrites, while levels of DNA damage and pro-inflammatory interleukin-6 were significantly reduced. In E MTX group catalase activity remained unaltered while significant lipid peroxidation and DNA damage reductions were seen only after six weeks. L-t MTX + DOLE group showed only modest alterations of cell damage parameters during six weeks. Combined administration of DOLE with MTX contributes to faster reduction of cell damage, restores oxidative balance and improves interleukin-6 suppression during high disease activity in early phase RA, but not in long term patients. Copyright © 2016 John Wiley & Sons, Ltd.

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Introduction/Objective Increasing spondyloarthritis (SpA) prevalence in the last several decades cannot be attributed to disease manifestations alone. The objective of this paper is to review the prevalence of SpA and its subtypes: ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), SpA related to inflammatory bowel disease (IBD) and undifferentiated SpA (UnSpA). Methods MEDLINE literature search was done via PubMed, Google Scholar, and Embase databases, using terms for spondyloarthritis, and prevalence, with an additional hand searching. Results As compared with southern European countries, northern European countries (Scotland, Sweden, France) showed lower SpA prevalence rates (0.21-0.45% vs. 1.06% and 1.35% in Italy and Turkey, respectively). The lowest world SpA prevalence was in African and Southeast Asian countries (0-0.19%), and the highest was in Alaska (2.5%). The widest variability in PsA prevalence was in Europe (northern 0.02-0.19%, southern 0.42%). The lowest world PsA prevalence was in Japan (0.001%), followed by China (0.01-0.10%). The European ReA prevalence ranged from 0.04% in Greece to 0.10% in Serbia and Germany, and the European UnSpA prevalence varied from 0.02% in Serbia to 0.67% in Germany; the highest world UnSpA prevalence was in Lebanon (3.4%). Studies aimed at estimating the SpA prevalence differed in sampling strategy and confirmation criteria, different cutoffs for age groups inclusion, presentation of standardized or row results, etc. Conclusion Variation in the SpA prevalence cannot be attributed to genetic or geographic distribution only. Differences in methodology of studies add to the diversification, described more in-depth in this review.