Onset age affects mortality and renal outcome of female systemic lupus erythematosus patients: a nationwide population-based study in Taiwan

Chen, Yi Ming; Lin, Ching Heng; Chen, Hsin‐Hua; Chang, Shih Ni; Hsieh, Tsu‐Yi; Hung, Wei Ting; Hsieh, Chang‐Wei; Lai, Kuo-Lung; Lan, Joung Liang; Chen, Der Yuan; Lan, Tsuo-Hung

doi:10.1093/rheumatology/ket330

Cited by 52 publications

(51 citation statements)

References 27 publications

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“…In another study in an attempt to minimize the effect of age on mortality, an age-matched control group was included, and, in conclusion, death risk in late-onset SLE patients was detected to be higher than that in adult-onset SLE patients. 13 The study of Merola et al, 5 likewise, pointed out advanced age at the diagnosis as a predictor of decreasing 10-year survival, in particular. 5 In the study of Bernatsky et al, 1 short disease term (<1 year) has increased standardized mortality ratio 5.4 times (95% confidence interval 4.7-6.3).…”

Section: Discussionmentioning

confidence: 99%

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Survival Analysis of Turkish Patients With Systemic Lupus Erythematosus: Older Age at Diagnosis Affects Mortality

Teke

Korkmaz

2017

Arch Rheumatol

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Objectives: This study aims to determine the rate, causes, and risk factors of mortality in Turkish systemic lupus erythematosus (SLE) patients and whether age at diagnosis has an effect on mortality or not. Patients and methods:We retrospectively analyzed the data from 221 patients (10 males, 211 females; mean age 41.5±13.5 years; range 18 to 74 years) who were followed-up due to the diagnosis of SLE in our department between January 1998 and March 2016. Detailed clinical findings, organ involvements, autoantibodies, and complement levels of the patients were recorded. Results: Of the entire group, 19 patients (8.6%) died. Mortality incidence rate was 1.05/100 patient-years. Most frequent causes of death were infections, ischemic cardiovascular and cerebrovascular diseases. Through univariate analysis, older age at diagnosis and a short duration of follow-up were identified as the only factors with an influence on mortality (p=0.004 and p=0.002, respectively). Beyond the mentioned factors, organ involvements in SLE, autoantibodies or antiphospholipid antibody syndrome were not found to have a relationship with mortality. Further analysis conducted on late-onset, defined as the patient age of 50 or above at diagnosis, versus adult-onset, defined as the diagnosis at an age of younger than 50 years, revealed a remarkably shorter survival in patients diagnosed after age of 50 (p=0.003). Cumulative five-year, 10-year, and 15-year survivals of patients were 91.9%, 90%, and 88.2%, respectively. Conclusion: We identified older age at diagnosis as an effective factor on mortality. SLE patients who are diagnosed at an older age should be more closely and meticulously followed-up than those diagnosed earlier in terms of their mortality risk.

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Section: Discussionmentioning

confidence: 99%

“…11,12 There are studies which have associated survival with the age at the diagnosis of SLE. 3,5,[11][12][13] Being diagnosed after the age of 50 years has been associated with poor survival. 3 Ruiz-Irastorza et al 11 have identified older age at the time of diagnosis as an independent risk factor for mortality.…”

Section: Discussionmentioning

confidence: 99%

Survival Analysis of Turkish Patients With Systemic Lupus Erythematosus: Older Age at Diagnosis Affects Mortality

Teke

Korkmaz

2017

Arch Rheumatol

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“…The onset of SLE among the Asian SLE population beyond the age of 50 years is reported to be 4-10%. [40][41][42] Though SLE is more common in females, the female preponderance reduces in late-onset disease. [42][43][44][45] This drastic change is due to the absence of female sex hormones in elderly patients.…”

Section: Systemic Lupus Erythematosusmentioning

confidence: 99%

“…63 In fact, mortality rates have been found to be higher in these patients due to infections, with 5, 10 and 15-year survival rates being 80.4%, 56.5% and 31.7% respectively. 40,41,43 Gout Gout is a heterogeneous disorder that results in the deposition of uric acid salts and crystals in and around joints and soft tissues. Elderly-onset gout (EOG) is appearance of gout after the age of 60 or 65 years and present with atypical findings.…”

Section: Outcomementioning

confidence: 99%

Rheumatic disease in elderly population, how different from the conventional presentations?

Dhaon¹,

Tripathy²

2016

IJRCI

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“…Juvenile SLE (JSLE) is characterized by an exaggerated immune response with highly activated autoreactive B lymphocytes, dysregulated immune regulatory pathways, and frequent involvement of the renal, hematological and central nervous systems (3)(4)(5). Children with JSLE also have a higher disease severity and a significantly higher mortality risk compared to patients with adult onset disease (6,7). Timely diagnosis and treatment have been shown to significantly improve the prognosis and the clinical management of JSLE (8).…”

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confidence: 99%

Clinical applications of the indirect immunofluorescence assay for detection of anticell membrane-associated DNA antibodies in juvenile systemic lupus erythematosus

Zhao

Xie

et al. 2014

Pediatr Res

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Background: Juvenile-onset systemic lupus erythematosus (JSLE) has a higher mortality risk compared to adultonset SLE. We compared the diagnostic value of anti-cmDNA antibodies with that of antinucleosome antibodies (AnuA), anti-Sm antibodies, and anti-dsDNA antibodies and human B lymphocyte Raji cells with that of human promyelocytic leukemia HL60 cells as substrates in an indirect immunofluorescence assay to detect anti-cmDNA antibodies in JSLE patients. Methods: We recruited 92 JSLE patients and 71 patients with other juvenile-onset rheumatic diseases. Anti-cmDNA antibodies and antinuclear antibodies (ANA) were detected in patient sera using indirect immunofluorescence assays. Anti-dsDNA antibodies were detected by combining ELISA and indirect immunofluorescence. Anti-Sm antibodies were detected by double immunodiffusion assay and immunoblotting, while AnuA were detected by ELISA. results: The JSLE group had a significantly higher percentage of patients positive for anti-cmDNA compared to patients with other rheumatoid diseases. Using one antibody for diagnosis, anti-cm DNA antibodies had the highest accuracy at 84.0%; using two antibodies, the combination of anti-cm DNA and anti-dsDNA antibodies had 90.8% accuracy. Raji cells used as substrate demonstrated a stronger intensity of fluorescent patterns compared to HL60 cells. conclusion: The high sensitivity, specificity, and accuracy of detection of anti-cmDNA antibodies make it a valuable diagnostic tool for JSLE. s ystemic lupus erythematosus (SLE) is an autoimmune disease characterized by the presence of autoimmune antibodies against a number of nuclear and nonnuclear antigens, resulting in immune complex-mediated inflammation and systemic, multiple organ failure (1). Almost 15-20% of all SLE patients are below the age of 18 (ref. 2). Juvenile SLE (JSLE) is characterized by an exaggerated immune response with highly activated autoreactive B lymphocytes, dysregulated immune regulatory pathways, and frequent involvement of the renal, hematological and central nervous systems (3)(4)(5). Children with JSLE also have a higher disease severity and a significantly higher mortality risk compared to patients with adult onset disease (6,7). Timely diagnosis and treatment have been shown to significantly improve the prognosis and the clinical management of JSLE (8).Disease activity in SLE patients is currently evaluated using the SLE activity index (SLEDAI), the systemic lupus activity measure, and the British Isles Lupus Assessment Group (9). Recently, the anti-Smith (Sm) antibodies, anticell membrane DNA (cmDNA) antibodies, antidouble strand DNA (dsDNA) antibodies, antinuclear antigen (ANA) antibodies, antinucleosome (AnuA) antibodies, anti-C1q antibodies, and antiphospholipid antibodies have been proposed as useful biomarkers of JSLE (10-16). Anti-dsDNA antibodies, anti-Sm antibodies and antiphospholipid antibodies are included in the diagnostic criteria outlined by the American College of Rheumatology (10). JSLE patients were shown to be more frequently positive ...

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Onset age affects mortality and renal outcome of female systemic lupus erythematosus patients: a nationwide population-based study in Taiwan

Abstract: Female patients with late-onset SLE carried a higher risk of mortality than those with adult-onset disease in the presence of co-morbidities. Juvenile-onset SLE patients were at greatest risk of mortality, which is probably due to disease severity.

Cited by 52 publications

References 27 publications

Survival Analysis of Turkish Patients With Systemic Lupus Erythematosus: Older Age at Diagnosis Affects Mortality

Survival Analysis of Turkish Patients With Systemic Lupus Erythematosus: Older Age at Diagnosis Affects Mortality

Rheumatic disease in elderly population, how different from the conventional presentations?

Clinical applications of the indirect immunofluorescence assay for detection of anticell membrane-associated DNA antibodies in juvenile systemic lupus erythematosus

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