AB0550 Clinical-epidemiological features of patients with a late-onset lupus in a tertiary care hospital

Abstract

BackgroundDifferent frequency of clinical and serological manifestations has been detected according to the age of onset of the patients with Systemic lupus erythematosus (SLE). According to the literature, senile SLE manifests between 6% and 18% of the patients with lupus.ObjectivesTo identify and analyse the clinical-serological and epidemiological features of senile SLE in our environment.To determine the average survival time and mortality in these patients, identifying its main cause.MethodsObservational retrospective study of 319 patients diagnosed with SLE (according to ACR 1992 and SLICC 2012 criteria) at the Hospital of León between 1997–2017 and with an age of onset ≥65 years, obtaining a total of 68 patients with senile SLE.ResultsThe mean age at diagnosis was 75.4±12.1 years, with a female/male ratio of 2.4. The most frequent manifestations were as joint (63.2%) and haematological manifestations in the form of leuco-lymphopenia (55.9%). The hemolytic anaemia only appeared in 2.9% of the cases and the thrombocytopenia in 25%. 36.8% of patients showed photosensitivity and 29% had other cutaneous manifestations, being the malar erythema the most prevalent type (60%), followed by the discoid lupus erythematosus (20%) and the subacute lupus (15%). Alopecia was only observed in 4.4%. Lupus nephritis was detected in the form of proteinuria in 4.4% of the patients, and only one patient had microscopic haematuria. Lung involvement was uncommon (8.8%), taking precedence the UIP (33.3%) over the rest of the pulmonary manifestations. Only 11.1% of the patients with senile SLE had serositis, being in the form of pleuritis in 75% of the cases, pericarditis in the 37.5% and ascites in the 12.5%. Regarding the neurological involvement, 5 patients showed polyneuropathy and 1 had chorea. Likewise, the frequency of Sjögren, Raynaud and secondary antiphospholipid syndrome was of 16.7%, respectively.The most important serological findings were: 97.3% ANA; 44.1% DNA and 20.6% hypocomplementemia, with 54.4% of the patients having serological activity. Only 5.9% had anti-Sm. Antiphospholipid antibodies were positive in 41.2% of the cases, with 4.4% of them showing triple positivity.The average survival time was of 13.7 years (SD: 10.9–16.5). Out of the total patients, 14 died (20.59%), mostly due to infectious etiology (35.7%) and 14.28% due to disease activity. Other less common causes were neoplasia or ischaemic heart disease (7.14% respectively).ConclusionsThe late–onset SLE prevails in our environment, one of every 5 patients diagnosed with SLE in our consulting room is older than 65 years.It is found most often in women and it is confirmed a lower male/female ratio than expected.Joint and haematology manifestations and cutaneous involvement in the form of malar erythema define the clinical profile of our patients with senile SLE, with the renal involvement or the presence of serositis being uncommon.Half of the patients had serological activity at the onset, having hypocomplementemia only in 1 out of 5 cases.Infections w...