Late-onset systemic lupus erythematosus: characteristics and outcome in comparison to juvenile- and adult-onset patients—a multicenter retrospective cohort

• Published in: Clinical rheumatology Vol. 39; no. 2; pp. 435 - 442
• Main Authors: Medhat, Basma M, Behiry, Mervat Essam, Sobhy, Nesreen, Farag, Yomna, Marzouk, Huda, Mostafa, Noha, Khalifa, Iman, Elkhalifa, Marwa, Eissa, Basma M., Hassan, Eman Hassan ElSayed
• Format: Journal Article
• Language: English
• Published: London Springer London 01.02.2020; Springer Nature B.V
• Subjects: Adolescent; Adult; Age of Onset; Aged; Child; Comorbidity; Egypt - epidemiology; Female; Geriatrics; Glucocorticoids - administration & dosage; Health risk assessment; Humans; Immunosuppressive Agents - administration & dosage; Lupus; Lupus Erythematosus, Systemic - drug therapy; Lupus Erythematosus, Systemic - epidemiology; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Nephritis; Original Article; Retrospective Studies; Rheumatology; Serositis; Severity of Illness Index; Systemic lupus erythematosus; Young Adult; Egypt; Juvenile; Systemic lupus erythematosus; Characteristics; Elderly onset; Late onset; Disease outcome
• ISSN: 0770-3198; 1434-9949
• DOI: 10.1007/s10067-019-04776-y

Introduction The aim of this study was to investigate the characteristics and outcome of systemic lupus erythematosus (SLE) among elderly-onset patients. Methods This study included 575 SLE patients managed at Cairo, Alexandria, and Helwan universities from August 2014 to 2018: of whom 49 (8.5%), 420 (73%), and 106 (18.4%) were elderly- (> 50 years), adult- (17–50 years), and juvenile- (≤ 16 years) onset patients, respectively. Cumulative characteristics were recorded. Disease activity at the last visit was investigated through the Systemic Lupus Erythematosus Disease Activity Index-2K (SLEDAI-2K), whereby lupus low disease activity (LLDA) was defined as a SLEDAI-2K score ≤ 4. The disease outcome was assessed through investigating disease damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)) and the prevalence of mortality. Quantitative and categorical data were compared using Kruskal–Wallis and Mann–Whitney tests, and chi-square ( χ 2 ) test, respectively. Results Late-onset SLE (LSLE) patients demonstrated the lowest prevalence of constitutional and mucocutaneous manifestations ( p  < 0.001), serositis ( p  = 0.006), nephritis ( p  < 0.001), neuropsychiatric involvement ( p  < 0.001), and hypocomplementinemia ( p  < 0.001), but showed the highest prevalence of comorbidities and multimorbidity (comorbidities ≥ 2) ( p  < 0.001), and positive anti-ds DNA antibodies ( p  < 0.001). Elderly-onset patients demonstrated the lowest SLEDAI-2K and SDI scores, achieved LLDA the most ( p  < 0.001), and developed any damage (SDI ≥ 1) the least ( p  < 0.001). The prevalence of mortality was comparable across the three age groups ( p  = 0.6). Conclusions Late-onset SLE patients (8.5%) showed the lowest prevalence of major organ involvement and the highest prevalence of comorbidities, and demonstrated more favorable disease activity and damage indices. Key Points • The disease characteristics and outcome among LSLE patients are characterized by being controversial, with studies from the Middle East being limited. Our cohort constituted of 8.5% elderly-onset SLE patients—who were characterized by the lowest prevalence of major organ involvement and the lowest activity and damage indices—making the disease pattern more favorable in this age group, despite being characterized by the highest prevalence of comorbidities.