RESEARCH - Clinical features and prognosis of late-onset SLE: results from the 1000 Faces of Lupus Study

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J Rheumatol.

Clinical Features and Prognosis of Late-onset Systemic Lupus

Erythematosus: Results from the 1000 Faces of Lupus Study.

Lalani S, Pope J, de Leon F, Peschken C.

From the University of Western Ontario, London, Ontario; McMaster

University, Hamilton, Ontario; and the University of Manitoba,

Winnipeg, Manitoba, Canada.

OBJECTIVE: There is controversy whether older-onset systemic lupus

erythematosus (SLE) is associated with a different, more benign

disease course than in younger-onset SLE. Our objective was to

characterize the clinical features and prognosis of late-onset SLE in

a large, multicenter cohort.

METHODS: We studied adult-onset lupus in the 1000 Canadian Faces of

Lupus cohort (n = 1528) of whom 10.5% had onset at age >/= 50 years

versus a control group with onset at < 50 years.

RESULTS: Disease duration was different in early- and late-onset

groups (15 yrs in early vs 9.3 yrs in late; p < 0.001). Caucasians

were represented more in the later-onset SLE group (55.6% vs 74.5%),

while Asians and Blacks were more prevalent in the younger group.

Younger-onset SLE subjects fulfilled more American College of

Rheumatology criteria for SLE (< 50 yrs: 5.98 +/- 1.68; >/= 50 yrs:

5.24 +/- 1.44; p < 0.0001). Despite an equal prevalence of anti-dsDNA,

the younger-onset group more often had positive anti-

autoantibody, ribonucleoprotein, and hypocomplementemia, and more

nephritis, rash, and cytopenias than the older-onset group. However,

disease activity and damage accrual were higher in the older-onset

group. The older patients received less prednisone and

immunosuppressives (current and ever-use). As expected, comorbidity

was higher in the older-onset SLE group.

CONCLUSION: This study suggests that older age-onset SLE is not

benign. There may be an interaction between lupus and age in which,

although there is less lupus nephritis in the elderly, more disease

activity and damage are present.

PMID: 20008925

http://www.ncbi.nlm.nih.gov/pubmed/20008925

Not an MD