Disease evolution in late-onset and early-onset systemic lupus erythematosus

Abstract

Objective The objective of this study was to compare clinical features, disease activity, and outcome in late-onset versus early-onset systemic lupus erythematosus (SLE) over 5 years of follow up Method Patients with SLE since 1970 were followed prospectively according to standard protocol and tracked on a computerized database. Patients entering the cohort within one year of diagnosis constitute the inception cohort. Patients with late-onset (age at diagnosis ≥50) disease were identified and matched 1:2 based on gender and first clinic visit (±5) years with patients with early-onset disease (age at diagnosis 18-40 years). Results A total of 86 patients with late-onset disease (84.9% female, 81.4% Caucasian, mean age at SLE diagnosis ± SD 58.05 ± 7.30) and 169 patients with early-onset disease (86.4% female, 71% Caucasian, mean age at SLE diagnosis ± SD 27.80 ± 5.90) were identified. At enrollment, late-onset SLE patients had a lower total number of American College of Rheumatology (ACR) criteria, with less renal and neurologic manifestations. Mean SLE Disease Activity Index 2000 (SLEDAI-2K) scores were lower in late-onset SLE, especially renal features and anti-dsDNA positivity. Over 5 years, mean SLEDAI-2K scores decreased in both groups, while mean Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI) scores increased more significantly in the late-onset group; they developed more cardiovascular, renal, and ocular damage, and had higher prevalence of cardiovascular risk factors. Conclusion Although the late-onset SLE group had a milder presentation and less active disease, with the evolution of disease, they developed more organ damage likely as a consequence of cardiovascular risk factors and aging.

Late-onset biopsy-proven lupus nephritis without other associated autoimmune diseases: severity and long-term outcome

“…[11][12][13][14] Despite the small number of patients in the late group, this percentage of late onset is comparable to previous studies (about 15% of late-onset LN). 17 Finally, our data provides novel evidence that late-onset nephritis without other associated autoimmune diseases has comparable long-term outcomes to early-onset nephritis. This finding is most likely explained by the observation that at presentation, late-onset nephritis has clinical, laboratorial and histological features similar to early-onset nephritis.…”

“…Subsequent evaluation of this same cohort revealed that elderly patients have, in fact, milder activity scores. 17 A cross-sectional study also compared early-onset LN developed within 5 years (n ¼ 187) with delayedonset LN (after 5 years, n ¼ 48) and concluded that delayed LN is not uncommon and is often associated with autoimmune diseases such as Sjogren and antiphospholipid syndrome. 16 Since in these concomitant conditions the kidney is also a target organ, the nonexclusion of these patients hampers the interpretation of nephritis related exclusively to lupus.…”

“…However, the inclusion of elderly patients (without age matching) precluded a definitive conclusion about their findings. 15,17 In addition, a cross-sectional study observed that delayed LN may identify patients at risk for associated autoimmune diseases. 16 The aim of this study was therefore to compare the clinical, laboratorial and histological features at presentation of late-and early-onset LN without associated conditions, at presentation and at longterm outcome.…”

“…However, the inclusion of elderly patients (without age matching) precluded a definitive conclusion about their findings. 15,17 In addition, a cross-sectional study observed that delayed LN may identify patients at risk for associated autoimmune diseases. 16…”

Concomitant systemic lupus erythematosus and HIV infection

“…[ 4 , 5 ] Such result is consistent with the recent findings that earlier onset of SLE may involve more renal features. [ 10 ] However, the etiology of renal involvement in cases with coexisting SLE and HIV is difficult to determine. Renal complications due to HIV are also diverse.…”