Late-onset Systemic Lupus Erythematosus Research Articles

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

Systemic lupus erythematosus (SLE) is a multisystem connective tissue disorder with varied clinical presentations with late onset SLE occurring after the age of 50. Involvement of the central nervous system (CNS) in SLE may range from non-focal symptoms of cognitive dysfunction, an acute confusional state, to focal symptoms of transient ischaemic attacks and strokes. We report a case of an elderly male who presented with confusion, functional decline and fevers. On admission, he was febrile with a Glasgow Coma Scale (GCS) of 11 with no other focal neurological or systemic examination findings. Initial investigations pointed towards a diagnosis of possible tuberculous meningitis with a differential diagnosis of unidentified sepsis and malignancy still being entertained. However, a newly developed purpuric skin rash helped clinch the diagnosis of SLE and he was finally diagnosed as a case of late-onset neuropsychiatric systemic lupus erythematosus (NPSLE). He was started on intravenous (IV) hydrocortisone which was later switched to a tapering dose of oral prednisolone and made a significant improvement.

Late-onset systemic lupus erythematosus in the elderly

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with various organs and systems involved in the pathological process. There is strong evidence that age at disease onset may influence the clinical presentations and prognosis of SLE. The paper analyzes the clinical and laboratory features of onset of SLE after the age of 50 years and possible reasons for differences in the manifestations of the disease in relation to racial and genetic factors. It considers the problems of differential diagnosis. There are data available in the literature and the results of the author's own investigations.

Late-onset systemic lupus erythematosus: clinical manifestations, course, and prognosis

Late-onset systemic lupus erythematosus: clinical manifestations, course, and prognosis

Comparison of clinical and serological differences among juvenile-, adult-, and late-onset systemic lupus erythematosus in Korean patients

We investigated whether systemic lupus erythematosus (SLE) patients could be distinguished based on the time of disease onset and, if so, whether the groups differed in their clinical and laboratory features in ethnically homogeneous Korean patients. We enrolled 201 SLE patients with available clinical data at the time of onset of SLE from the lupus cohort at Chonnam National University Hospital. Sociodemographic, clinical, and laboratory data, including autoantibodies, and concomitant diseases were found at the time of diagnosis of SLE by reviewing patient charts. We divided SLE patients according to age at SLE diagnosis into three groups: juvenile-onset SLE (JSLE, diagnosed at ≤ 18 years), adult-onset SLE (ASLE, diagnosed at 19-50 years), and late-onset SLE (LSLE, diagnosed at >50 years), and compared baseline demographic, clinical, and relevant laboratory findings. Of the 201 patients, 27 (14.4%), 149 (74.1%), and 25 (12.4%) were JSLE, ASLE, and LSLE patients, respectively. Fever, oral ulcers, nephritis, anemia, and thrombocytopenia were more common in JSLE patients than ASLE or LSLE patients (p < 0.05, < 0.05, 0.001, < 0.05, and < 0.05, respectively). However, Sjögren's syndrome was more frequent in LSLE patients than JSLE or ASLE patients (p < 0.05). Disease activity was significantly higher in JSLE patients than in ASLE or LSLE patients (p < 0.001). Anti-dsDNA and anti-nucleosome antibodies were found more frequently in JSLE patients and less frequently in LSLE patients (p < 0.05 and 0.005, respectively) and decreased complement levels were more common in JSLE patients and less common in LSLE patients (p < 0.001, 0.001, and < 0.05, respectively). Our results indicate that SLE patients present with different clinical and serological manifestations according to age at disease onset. JSLE patients have more severe disease activity and more frequent renal involvement and LSLE patients have milder disease activity, more commonly accompanied by Sjögren's syndrome, at disease onset.

Clinical picture of late-onset systemic lupus erythematosus in a group of Polish patients.

The prevalence of late-onset systemic lupus erythematosus (SLE) diagnosed in patients over the age of 50 years is estimated at 10% to 20%. SLE in elderly patients has specific features with misleading signs and symptoms, but its clinical course seems milder compared with that in younger patients. The aim of the study was to assess clinical manifestations of late-onset SLE in a group of patients treated in Poland. From a group of 230 consecutive patients with SLE, individuals with late-onset disease were selected. We retrospectively analyzed the incidence of clinical features of SLE, concomitant diseases, and treatment. The incidence of clinical features in late-onset patients was compared with that in a group of 108 patients with early-onset SLE. Late-onset SLE was confirmed in 20 patients (8.7%) including 16 women (80%) and 4 men (20%). A delay in diagnosis was 31.7 months (0-144). The most common SLE features were arthritis (50%), rash (40%), nephropathy (40%), photosensitivity (30%), mouth ulcerations (30%), interstitial lung disease (30%), fever (25%), leukopenia (65%), and thrombocytopenia (35%). Kidney involvement was present in all men and in 25% of women. Thrombotic complications were noted in 38.8% of the patients. Concomitant diseases were common in our study group. The clinical picture of late-onset SLE differs from that of early-onset SLE. Arthritis, leukopenia, and thrombotic complications are frequent, while skin manifestations, photosensitivity, nephropathy, vasculitis, and central nervous system involvement are less common in late-onset SLE. The diagnosis of late-onset SLE is often delayed, and treatment is determined by the presence of concomitant diseases.

Association of mtDNA M/N haplogroups with systemic lupus erythematosus: a case-control study of Han Chinese women.

To investigate whether mitochondrial DNA haplogroups M or N are related to occurrence or manifestations of systemic lupus erythematosus (SLE), we collected M/N haplogrouping and clinical characteristics from 868 Han Chinese women with SLE, as well as for 870 age-matched healthy Han Chinese control women. M/N haplogroups were determined in all subjects using allele-specific amplification. The frequency of M haplogroup in all patients was 429 (49.4%) and the frequency of N haplogroup, 439 (50.6%). The corresponding frequencies in controls were 456 (52.4%) and 414 (47.6%) (P = 0.213). Among women older than 50 years at onset age, the N haplogroup was significantly higher in patients than in healthy controls (59.6% vs 41.7%, P = 0.042). The N haplogroup was associated with significantly higher risk for certain SLE characteristics: hematological system damage (OR 2.128, 95%CI 1.610 to 2.813), skin impairment (OR 1.873, 95%CI 1.428 to 2.457), neurological disturbance (OR 3.956, 95%CI 1.874 to 8.352) and alopecia (OR 1.322, 95%CI 1.007 to 1.737 ). Our results suggest that in Han Chinese women, the mtDNA N haplogroup is associated with higher risk of late-onset SLE, skin impairment, neurological disturbance, hematological system damage and alopecia.

Clinical, serologic, and immunogenetic characterization (HLA-DRB1) of late-onset lupus erythematosus in a Colombian population.

Late-onset systemic lupus erythematosus (SLE) represents a specific subgroup that is defined as onset after 50 years of age. Late-onset lupus may have a different clinical course and serological findings, which may delay diagnosis and timely treatment. The objective of this paper is to determine the clinical, serologic, and immunogenetic differences among Colombian patients with late-onset SLE versus conventional SLE patients. This was a cross-sectional study in a Colombian population. Patients and their medical records were analyzed from the services of Rheumatology in Bogotá and met the criteria for SLE, according to the American College of Rheumatology (ACR) revised criteria for the classification of SLE.In a reference group of late-onset SLE patients (98 participants, with an onset after 50 years of age) and a group of conventional SLE patients (72 participants, with an onset of age of 49 years or less), multiple clinical variables (age, clinical criteria for lupus, alopecia, weight loss, fever, Raynaud's phenomenon) and multiple serological variables (blood count, blood chemistry profile, autoantibodies) were analyzed. Additionally, the HLA class II (DRB1) of all the patients was genotyped, including an additional group of patients without the autoimmune disease. Statistical analysis was performed using the STATA 10.0 package. In the group of late-onset lupus, there was a higher frequency of pleurisy (p = 0.002), pericarditis (p = 0.026), dry symptoms (p = 0.029), lymphopenia (p = 0.007), and higher titers of rheumatoid factor (p = 0.001) compared with the group of conventional SLE. Late-onset SLE patients had a lower seizure frequency (p = 0.019), weight loss (p = 0.009), alopecia (p < 0.001), and Raynaud's phenomenon (p = 0.013) compared to the conventional SLE group. In late-onset SLE, HLA DR17 (DR3) was found more frequently compared with individuals without autoimmune disease (OR 3.81, 95% CI 1.47 to 10.59) (p = 0.0016). In the Colombian SLE population analyzed, there may be a probable association of several clinical and serologic variants, which would allow the differentiation of variables in the presentation of the disease among patients with late-onset SLE vs. conventional SLE.

Tuberculosis in Patients with Systemic Lupus Erythematosus: Five Year Experience of a Single Center in Northern Taiwan

Objective: Tuberculosis (TB) is one of the most severe infectious diseases worldwide. Previous studies have shown a higher prevalence of TB infection in patients with systemic lupus erythematosus (SLE) in South-East Asia, including Taiwan. This study aimed to analyze cases of TB in patients with SLE in a single center from 2008 to 2013. Methods: We retrospectively reviewed the medical records of patients with SLE who were followed up at National Taiwan University Hospital from May, 2008 to April, 2013, including both inpatient and outpatient departments. Age, gender, disease duration, medications, cause of death, and treatment response to TB were documented and analyzed. Results: A total of 1615 patients with SLE were enrolled in this study. TB was diagnosed in 18 patients, with a prevalence rate of 1.11%. The average age of the patients with SLE and TB was 50 ± 14.4 years, with a female to male ratio of 13:5, and 56% of the patients had extrapulmonary involvement. The patients with SLE and TB were significantly older than the non-TB group (p=0.027). The prevalence of TB was also higher in the male and patients with late-onset SLE. The TB-related mortality rate was 5.5%. Most patients received glucocorticoids, and the mean daily dosage was 12.1 ± 8.7 mg prednisolone or equivalent. Conclusion: The average age of the patients with SLE and TB was older than that of those without TB. In patients with SLE, TB may be a particularly important issue in males, patients with late-onset SLE, and in older patients with concomitant steroid use.

Optimizing pharmacotherapy of systemic lupus erythematosus: the pharmacist role.

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that can affect any part of the body. The management of the disease includes nonpharmacotherapy and pharmacotherapy. To provide an up-to-date review of the etiology, epidemiology, clinical features, diagnostic findings, and treatment options for SLE. METHODS DATA SOURCE: A PubMed search of English language journals using a combination of words--elderly, SLE, late onset SLE, etiology, screening, diagnosis, or treatment to identify original studies, guidelines, and reviews on SLE, SLE, late onset SLE published between 2000 and present. Overall, original studies, clinical reviews, references, and guidelines were obtained and evaluated on their clinical relevance. The literature included guidelines and considerations for the etiology, diagnosis, screening, and management of SLE, late onset SLE. SLE is a chronic autoimmune disorder, the exact etiology of which is unknown. SLE predominately affects younger women; however, it is reported to occur in up to 20 % of patients 50 years or older. In patients with SLE, nearly every system in the body is affected with varying degrees of severity ranging from subclinical to fatal. The hallmark feature of SLE is the production of autoantibodies directed primarily against nuclear antigens, but also against cytoplasmic components of cells. The diagnosis of SLE is based on criteria set by the American College of Rheumatology. Management is individualized and depends on presenting symptoms and reducing the likelihood of permanent damage to organs and tissues.

FRI0417 Comparison of Clinical and Serological Manifestations among Juvenile-, Adult-, and Late-Onset Systemic Lupus Erythematosus Patients in Korea

BackgroundUp to 30-40% of patients with systemic lupus erythematosus (SLE) experience their onset prior to adulthood or at over 50 years of age. Patients with juvenile-onset SLE (JSLE) frequently present...

THU0026 Greater Diagnostic Delay in Early-Onset than in Late-Onset Systemic Lupus Erythematosus - Data from Reuma.Pt/Les

BackgroundSystemic lupus erythematosus (SLE) affects predominantly women of reproductive age. However, in about 15% of patients SLE begins before the age of 18 years (early-onset) and in 10-20% of patients...

Clinical manifestations and survival among adults with (SLE) according to age at diagnosis

The objective of this paper is to determine the effect of clinical and laboratory manifestations, and medication prescribing, on survival according to patient age at diagnosis in a large academic systemic lupus erythematosus (SLE) cohort. We identified SLE patients with a diagnosis at age ≥18, seen between 1970 through 2011, and with more than two visits to our lupus center. Data collection included SLE manifestations, serologies, other laboratory tests, medications, dates, and causes of death. We examined characteristics of those diagnosed before age 50 (adult onset) compared to those diagnosed at or after age 50 (late onset) using descriptive statistics. We used Kaplan-Meier curves with log rank tests to estimate five- and 10-year survival in age-stratified cohorts. Predictors of 10-year survival were assessed using Cox regression models, adjusted for calendar year, race/ethnicity, sex, lupus nephritis, and medication use. Of 928 SLE patients, the mean age at diagnosis was 35. Among the adult-onset group, there was significantly higher prevalence of malar rashes and lupus nephritis. Glucocorticoids, azathioprine, mycophenolate, and cyclophosphamide use were also more frequent in the adult-onset group compared to the late-onset group. Five-year survival rates were 99.5% and 94.9% and 10-year survival rates were 97.8% and 89.5%, among those diagnosed before and at or after age 50. In the entire cohort, increasing age at diagnosis, male sex, and black race were statistically significant predictors of reduced 10-year survival. Compared to those diagnosed before age 50, the late-onset group had a multivariable-adjusted hazard ratio for 10-year risk of death of 4.96 (95% CI 1.75-14.08). The most frequent cause of known death was a lupus manifestation, followed by cardiovascular disease and infection. In our cohort, several demographic features, SLE manifestations, and medication prescribing differed between those with adult-onset and late-onset SLE. Ten-year survival rates were high for both groups, but relatively lower among late-onset patients. A lupus manifestation as the cause of death was more common among adult-onset compared with late-onset patients.

84-Year-Old Man With Night Sweats, Weight Loss, and Diarrhea

An 84-year-old man with a history of coronary artery disease, hypertension, hyperlipidemia, ischemic stroke, and gastroesophageal reflux disease presented to the outpatient gastroenterology clinic with a 3-month history of night sweats, generalized weakness, nausea, vomiting, nonbloody postprandial diarrhea, and an 18-kg weight loss. He also reported a recent rash and daily morning stiffness in his fingers and knees lasting up to about 30 minutes. He denied alcohol or intravenous drug abuse. Previously, he had been taking several medications, but all had been recently discontinued because of the persistent diarrhea. On examination, the patient had normal vital signs. He appeared cachectic, with a distended abdomen with flank dullness but no pain on palpation. The joints of his fingers and knees were tender to palpation, and soft tissue swelling was evident. No other abnormalities were found on examination of the head, ears, eyes, nose and throat, skin, and lymphatic, cardiac, respiratory, and thyroid systems. A computed tomographic (CT) scan of the abdomen and pelvis obtained 1 month previously at another institution revealed abdominal and pelvic ascites and mildly prominent aortocaval and periportal lymph nodes. A positron emission tomographic/CT scan also obtained at another facility did not suggest malignancy.

Interstitial pneumonia as an initial manifestation in a patient with late‐onset SLE

Interstitial pneumonia as an initial manifestation in a patient with late‐onset <scp>SLE</scp>

10.5937/mckg48-6173 = Late-onset systemicus lupus erithematosus

There is an assumption that the late-onset systemic lupus erythematosus (SLE), with the beginning after the age of 50, has a different clinical course, with an insidious start and non-specific first manifestations. The incidence of late-onset SLE is 12-20% of all patients with SLE. Atypical presentation, nonspecific initial clinical manifestations and smaller incidence of SLE in elderly population may contribute to the delayed diagnosis. It could be concluded that despite the less major organ involvement (nephritis, central nervous system), and more benign course of disease, late-onset SLE has poorer prognosis, because of the higher frequency of co-morbid conditions and higher organ damage, due to the aging and longer exposition to typical vascular risk factors. The prognosis depends not only on the disease per se, but on the clinical context in which it occurs. Strategies to reduce the occurrence of cardiovascular disease, osteoporosis, pathological fractures, infections and other forms of damage should be aggressively implemented particularly in the late-onset patients, and they have to be closely followed because they are more susceptible to damage in long-term follow-up.

Associations of clinical features and prognosis with age at disease onset in patients with systemic lupus erythematosus

The objective of this study is to evaluate the association of clinical features and prognosis with age at disease onset in patients with systemic lupus erythematosus (SLE) in a large, multicenter Chinese cohort. Medical records of 1898 SLE inpatients from 15 hospitals were reviewed and classified into three groups according to their ages at disease presentation. Categorical data were analyzed by chi-square test and potentially associated factors were tested by multinomial logistic regression. Among the patients studied, 259 (13.6%) were juvenile onset (≤18 years), 1444 (76.1%) were early onset (>18 and ≤45 years) and 195 (10.3%) were late onset (>45 years). Whenever manifestations occurred, most patients (>80%) were diagnosed within two years. Juvenile-onset patients were more likely to be untreated before admission (p < 0.001) and have mucocutaneous manifestations (p < 0.001), but musculoskeletal symptoms (p < 0.05) and leukopenia (p < 0.05) were less frequent, while comorbidities were much higher in patients with late-onset SLE (p < 0.001). Neuropsychiatric, cardiopulmonary, renal and gastrointestinal involvement, disease activity index and damage scores were similar among three groups. Anti-Sm antibodies were less prevalent in late-onset patients (p < 0.05) and antimalarial drugs were more often applied to juvenile-onset patients (p < 0.001). As expected, mortality was elevated in the late-onset SLE group (p < 0.05), in which nearly half died of infections, which was much higher than those in the other two groups (p < 0.001). Logistic regression confirmed that patients with juvenile- and early-onset disease were associated with high incidence of being untreated prior to admission, and with low incidence of comorbidities as well as deaths caused by infection compared to patients with late-onset lupus. Interestingly, our data showed that more patients with late-onset disease had a SLEDAI score change of >7 at discharge. In conclusion, age at onset has an impact on SLE disease status, and infection is the main cause of death in those with late-onset lupus. Considering that the late-onset patients had simultaneously easily controllable diseases and high incidence of comorbidities, a different treatment strategy from younger patients should be considered.

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

The objective of this study was to investigate the impact of disease onset age on mortality and renal survival in female SLE patients. This nationwide, population-based, retrospective cohort study used data from the National Health Insurance Research Database of Taiwan. Female patients newly diagnosed with SLE from 2001 to 2004 were identified as the study cohort. A non-SLE group was matched for age, sex and initial diagnosis date (index date) as the comparison cohort. Co-morbidities, mortality rates and end-stage renal disease (ESRD) incidences were compared among SLE patients of different onset age. Hazard ratios with a 95% CI were determined by the Cox proportional hazard model to quantify the mortality rates and ESRD incidences. Juvenile-onset, adult-onset and late-onset SLE patients were categorized according to disease onset age: <18, 18-50 and >50 years old. In total, 513 juvenile-onset, 3076 adult-onset and 764 late-onset SLE patients were identified. Compared with non-SLE controls, the hazard ratios of mortality were 6.49 (95% CI 3.73, 11.32, P < 0.001) for juvenile-onset, 1.75 (95% CI 1.47, 2.08, P < 0.001) for adult-onset and 3.44 (95% CI 2.76, 4.28, P < 0.001) for late-onset SLE patients. The hazard ratios of incident ESRD were 20.28 (95% CI 12.79, 32.15, P < 0.001) for adult-onset lupus patients and 1.99 (95% CI 1.36, 2.93, P < 0.001) for late-onset patients. 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.

Is there an Effective Treatment for Late-Onset Systemic Lupus Erythematosus?

Over the past 60 years, overall mortality in systemic lupus erythematosus patients has dramatically decreased, but late mortality, which relates to the damage caused by the disease, its treatments and/or evolving comorbidities, is still high. This is particularly true in patients with late-onset lupus, a special subgroup of patients who, despite not having very active disease, experience a larger number of comorbidities, and higher damage accrual and mortality rates than early-onset patients. Treating these late-onset patients can be more difficult due to the risk of drug–drug interactions and aging-related processes. Antimalarials should be used whenever possible, and glucocorticoids and immunosuppressive drugs must used be carefully, especially in this population. NSAIDs should be avoided if possible. Adequate treatment of comorbidities should improve these patients’ prognoses.

AB0636 Late-onset systemic lupus erythematosus: Clinical features, course and prognosis

BackgroundThere are contradictory opinions if late-onset systemic lupus erythematosus (SLE) is associated with a different, more benign disease course and better prognosis than early-onset SLE.ObjectivesThe objective of study was to...

AB0656 Clinical, serological and immunogenetic features of late-onset systemic lupus erythematosus in a colombian population

BackgroundLate-onset systemic lupus erythematosus (LOSLE) is a disease-specific subgroup, which begins clinically after 50 years of age. LOSLE may have unusual clinical and laboratory characteristics, which may delay the diagnosis...