A systematic review and meta-analysis of cutaneous manifestations in late- versus early-onset systemic lupus erythematosus

Abstract

Objectives Although systemic lupus erythematosus (SLE) most commonly occurs in reproductive-age women, some are diagnosed after age 50. Recognizing that greater than one third of SLE criteria are cutaneous, we undertook a systematic review and meta-analysis to evaluate differences in cutaneous manifestations in early and late-onset SLE patients. Methods We searched the literature using PubMed, CINAHL, Web of Science and Cochrane Library. We excluded studies that did not include ACR SLE classification criteria, early-onset controls, that defined late-onset SLE as <50 years of age, or were not written in English. Two authors rated study quality using the Newcastle Ottawa Quality Scale. We used Forest plots to compare odds ratios (95% confidence intervals) of cutaneous manifestations by age. Study heterogeneity was assessed using I2. Results Thirty five studies, representing 11,189 early-onset and 1,727 late-onset patients with SLE, met eligibility criteria. The female: male ratio was lower in the late-onset group (5:1 versus 8:1). Most cutaneous manifestations were less prevalent in the late-onset group. In particular, malar rash (OR 0.43 (0.35, 0.52)), photosensitivity (OR 0.72 (0.59, 0.88)) and livedo reticularis (OR 0.33 (0.17, 0.64)) were less common in late-onset patients. In contrast, sicca symptoms were more common (OR 2.45 (1.91, 3.14)). The mean Newcastle Ottawa Quality Scale score was 6.3 ±0.5 (scale 0–9) with high inter-rater reliability for the score (0.96). Conclusions Overall, cutaneous manifestations are less common in late-onset SLE patients, except sicca symptoms. Future studies should investigate etiologies for this phenomenon including roles of immune senescence, environment, gender and immunogenetics.

Clinical characteristics and survival of 413 patients with systemic lupus erythematosus in southeastern areas of South Korea: A multicenter retrospective cohort study

“…Although not always consistent across studies, patients with childhood‐onset SLE tend to have a more severe and aggressive disease, whereas patients with late‐onset SLE show a more indolent and less severe clinical course than those with adult‐onset SLE . In our cohort, renal involvement was more frequent in patients with childhood‐onset SLE, whereas typical cutaneous presentations, such as malar rash, were less common in patients with late‐onset SLE, which is similar to findings of previous reports . Both childhood‐onset and late‐onset SLE were associated with higher mortality than adult‐onset SLE in the present study (Table ), and this finding is in line with those of previous studies .…”

Autoantibody profile and clinical patterns in 619 Italian patients with cutaneous lupus erythematosus

“…These data agree with those of the literature as SLE is most common in patients below 50 years. 35 Particularly, early-SLE (age <50 years) seems to have cutaneous manifestations more often than late-SLE (age > 50 years). These differences seem to be associated with many factors including age, immunosenescence, environment and immunogenetics.…”

Neuropsychiatric systemic lupus erythematosus in a geriatric patient: A case report

“…[6] However, data literature within the late-onset group is conflicting. A very recent systematic review and metaanalysis done by Medlin et al [7] found that, while cutaneous signs are still common, they are less common compared to early-onset SLE with malar rash, photosensitivity and alopecia occurring less frequently and sicca symptoms being more common among the elderly group. This differed in our patient, in which the photosensitive rash helped us to clinch the diagnosis.…”