Elderly‐Onset Systemic Lupus Erythematosus

Fettig, Jade; Desiderio, Michael; Nagarajan, Vijaiganesh

doi:10.1111/jgs.12425

Cited by 4 publications

(6 citation statements)

References 3 publications

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“…Major organ involvement is also less frequent. Despite LO‐SLE having a more‐indolent course, mortality can be higher in elderly adults because of accompanying diseases …”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Systemic Lupus Erythematosus in an Elderly Man

Çınar

Atmış

Cengiz

et al. 2015

J American Geriatrics Society

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A. Comparative mechanisms for contraction of cardiac and skeletal muscle. Chest 1980;78(Suppl 1):123-139. 4. Stulz PM, Scheidegger D, Drop LJ et al. Ventricular pump performance during hypocalcemia: Clinical and experimental studies. J Thorac Cardiovasc Surg 1979;78:185-194. 5. Kazmi AS, Wall BM. Reversible congestive heart failure related to profound hypocalcemia secondary to hypoparathyroidism. Am J Med Sci 2007;333:226-229. 6. Zittermann A, Schleithoff SS, Tenderich G et al. Low vitamin D status: A contributing factor in the pathogenesis of congestive heart failure? J Am Coll Cardiol 2003;41:105-112. 7. Tomar M, Radhakrishnan S, Shrivastava S. Myocardial dysfunction due to hypocalcemia. Indian Pediatr 2010;47:781-783. 8. Maiya S, Sullivan I, Allgrove J et al. Hypocalcaemia and vitamin D deficiency: An important, but preventable, cause of life-threatening infant heart failure. Heart Br Card Soc 2008;94:581-584. A RARE CASE OF SYSTEMIC LUPUS ERYTHEMATOSUS IN AN ELDERLY MAN To the Editor: Systemic lupus erythematosus (SLE) is an autoimmune disorder with multiorgan involvement that occurs mainly in young women. Late-onset SLE (LO-SLE) is mainly used to describe individuals diagnosed after that age of 50. 1 Clinically, the disease is slow and insidious. The frequency of LO-SLE is reported to be between 6% and 18% of individuals with SLE; it is extremely rare after the age of 90. 2,3 CASE REPORTA 91-year-old man presented with fatigue, weakness, and weight loss lasting for 1 year, having lost 15 kg despite treatment with oral parenteral nutrition supplementation.Before symptom onset, he was independent in activities of daily living (ADLs) and instrumental ADLs, but for the previous 3 months he had needed support. Comprehensive Geriatric Assessment (CGA) Mini Nutritional Assessment score was 5, total CGA score was 15, Katz Index of Activities of Daily Living score was 2 out of 6, and Lawton and Brody Index of Instrumental Activity of Daily Living score was 2 out of 8. There were no pathological findings on physical examination. Laboratory tests showed hemoglobin 10.7 g/dL (normal 11.7-16.1 g/dL), hematocrit 31.7% (normal 37-51%), mean corpuscular volume 89.5 fL (normal 81-103 fL), blood ferritin 171 ng/mL (normal 24-336 ng/mL), erythrocyte sedimentation rate 102 mm/h (normal 0-20 mm/h), creatinine 1.26 mg/dL (normal 0.7-1.2 mg/dL), estimated glomerular filtration rate 44 mL/ min (normal >90 mL/min), albumin 2.4 g/dL (normal 3.5-5.2 g/dL), lactate dehydrogenase 121 U/L (normal 125-220 U/L), direct coombs +, and C-reactive protein (CRP) 39.7 mg/L (normal 0-3 mg/L). Spot urinalysis showed blood was positive for erythrocytes (50/lL; normal < 5/ lL) and 40 erythrocytes per high-power field, and 24-hour urinalysis revealed proteinuria (560 mg/d, normal < 140 mg/d). Complement C4 was 56 mg/dL (normal 12-72 mg/dL), and complement C3 was 0.901 g/L (normal 0.9-1.8 g/L). Evaluating for multiple myeloma, immunoglobulin (Ig)G was 32 g/L (normal 6-15 g/L), IgA was 7.68 g/L (normal 0.9-4 g/L), and serum and urinary electrophoresis ...

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“…Major organ involvement is also less frequent. Despite LO‐SLE having a more‐indolent course, mortality can be higher in elderly adults because of accompanying diseases …”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Systemic Lupus Erythematosus in an Elderly Man

Çınar

Atmış

Cengiz

et al. 2015

J American Geriatrics Society

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“…Although SLE often affects women of child-bearing age, approximately 10%-20% of the cases had elderly-onset lupus, and menopause and cellular immunity changes were the major contributors for elderly-onset SLE (Lazaro, 2007). Regarding the lack of treatment modalities and studies for the elderly-onset SLE (Rovenský and Tuchynová, 2008;Fettig et al, 2013), our study could serve as prima facie evidence to guide adding PCSK9 inhibitors (i.e., evolocumab) for the elder population with a high risk of SLE, especially those accompanied with abnormally high levels of LDL cholesterol. Before putting it into practice, studies are warranted to clarify whether PCSK9 inhibitors were efficacious in lowering SLE risk and disease severity, and the mechanism of their effect.…”

Section: Figurementioning

confidence: 99%

Association of lipid lowering drugs and the risk of systemic lupus erythematosus: a drug target Mendelian randomization

Wu,

Ye,

Wang

et al. 2023

Front. Pharmacol.

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Background and objective: An interaction between low-density lipoprotein level, lipid-lowering drugs, and systemic lupus erythematosus (SLE) was reported by previous studies. However, whether lipid-lowering drugs provided protective effect for reducing the risk of SLE was unclear. We aimed to clarify this causal relationship through a drug-target Mendelian randomization (MR) study.Methods: Genetic instruments—single nucleotide polymorphism (SNPs)—were utilized to proxy inhibition of the three genes—3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR), proprotein convertase subtilisin/kexin type 9 (PCSK9), and Niemann-Pick C1-Like 1(NPC1L1), which was corresponded to three lipid-lowering drugs—statins, evolocumab, and ezetimibe. Low-density lipoprotein (LDL) cholesterol was selected as the biomarker for the measurement of the inhibitors of HMGCR, PCSK9, and NPC1L1, and the genetic data were acquired from the Global Lipids Genetics Consortium, which consisted of 1.3 million participants of European ancestry and 146.5 thousand participants of East Asian ancestry. The genetic dataset of SLE was acquired from two large-scale GWAS studies; one recruited 23,210 participants (7,219 SLE cases and 15,991 controls) of European ancestry and the other one recruited 12,653 participants (4,222 SLE cases and 8,431 controls) of Chinese ancestry. The primary analysis used the inverse variance weighted (IVW) method. Four additional sensitivity analyses, colocalization analysis, and stratification analysis were performed.Results: The primary analysis showed that inhibition of PCSK9 (evolocumab) was associated with a significantly lower risk of SLE [odds ratio (OR) 0.51, 95%CI 0.34 to 0.76, p = 0.001] in the European population. The secondary analyses had similar findings. Stratification analysis demonstrated that the preventive effect of PCSK9 inhibition for SLE was similar in both males and females. However, the results were not replicated in the East Asian population. The inhibition of HMGCR (statins) and NPC1L1 (ezetimibe) did not cause a lower risk of SLE.Conclusion: Evolocumab might provide a protective effect on the risk of SLE in the European population, but statins and ezetimibe might not have the protective effect. Further research is necessary to elucidate the specific mechanisms and potential therapeutic applications of PCSK9 inhibitors (evolocumab) in the context of SLE protection.

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“…1 Studies comparing LO-SLE to non-LO-SLE (NLO-SLE) have been conflicting. [2][3][4][5][6] Some studies show a higher prevalence of autoantibodies such as SSA and SSB in LO than NLO-SLE patients 5,6 with other studies not demonstrating a difference in prevalence of autoantibodies. 2,7 Studies have examined the clinical presentation of LO and NLO-SLE patients.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5][6] Some studies show a higher prevalence of autoantibodies such as SSA and SSB in LO than NLO-SLE patients 5,6 with other studies not demonstrating a difference in prevalence of autoantibodies. 2,7 Studies have examined the clinical presentation of LO and NLO-SLE patients. 2,4 While LO-SLE patients were less likely to present with renal involvement, 2-4 they had higher rates of serositis, 4,5 more comorbid conditions such as cardiovascular disease, 3,5,7 and higher mortality rates.…”

Section: Introductionmentioning

confidence: 99%

“… 2 , 7 Studies have examined the clinical presentation of LO and NLO-SLE patients. 2 , 4 While LO-SLE patients were less likely to present with renal involvement, 2 – 4 they had higher rates of serositis, 4 , 5 more comorbid conditions such as cardiovascular disease, 3 , 5 , 7 and higher mortality rates. 5 , 7 As patients with SLE face diagnostic delays, understanding disease presentation in SLE is important to reducing diagnostic delays.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of late-onset and non-late-onset systemic lupus erythematosus individuals in a real-world electronic health record cohort

Adeogun,

Camai,

Suh

et al. 2024

Lupus

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Objective: Late-onset systemic lupus erythematosus (LO-SLE) is defined as SLE diagnosed at age 50 years or later. Current studies on LO-SLE are small and have conflicting results. Methods: Using a large, electronic health record (EHR)-based cohort of SLE individuals, we compared demographics, disease characteristics, SLE-specific antibodies, and medication prescribing practices in LO ( n = 123) vs. NLO-SLE ( n = 402) individuals. Results: The median age (interquartile range) at SLE diagnosis was 60 (56–67) years for LO-SLE and 28 (20–38) years for NLO-SLE. Both groups were predominantly female (85% vs. 91%, p = 0.10). LO-SLE individuals were more likely to be White than NLO-SLE individuals (74% vs. 60%, p = 0.005) and less likely to have positive dsDNA (39% vs. 58%, p = 0.001) and RNP (17% vs. 32%, p = 0.02) with no differences in Smith, SSA, and SSB. Autoantibody positivity declined with increasing age at SLE diagnosis. LO-SLE individuals were less likely to develop SLE nephritis (9% vs. 29%, p < 0.001) and less likely to be prescribed multiple classes of SLE medications including antimalarials (90% vs. 95%, p = 0.04), azathioprine (17% vs. 31%, p = 0.002), mycophenolate mofetil (12% vs. 38%, p < 0.001), and belimumab (2% vs. 8%, p = 0.02). Conclusion: LO-SLE individuals may be less likely to fit an expected course for SLE with less frequent positive autoantibodies at diagnosis and lower rates of nephritis, even after adjusting for race. Understanding how age impacts SLE disease presentation could help reduce diagnostic delays in SLE.

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Elderly‐Onset Systemic Lupus Erythematosus

Cited by 4 publications

References 3 publications

A Rare Case of Systemic Lupus Erythematosus in an Elderly Man

A Rare Case of Systemic Lupus Erythematosus in an Elderly Man

Association of lipid lowering drugs and the risk of systemic lupus erythematosus: a drug target Mendelian randomization

Comparison of late-onset and non-late-onset systemic lupus erythematosus individuals in a real-world electronic health record cohort

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