Rheumatic Disease in Geriatrics by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030442347
Publisher: Springer International Publishing

15.1 Late Onset SLE

Late onset SLE is defined as age of onset of 50 years and above and presents with a frequency of 2.9–18% cases of adult onset SLE [2, 8–13].

There is scarce data on the incidence or prevalence of SLE in elderly patients since most published series of late onset SLE do not give information on how many patients were diagnosed at age 65 or above. The mean age reported in published series is usually 55–58 years ±5–7 years. A single center Korean series encountered 21 SLE patients with disease onset at 65 years and older during a 10 year period. The ratio of lupus patients below age 65 years to patients over 65 years was more than 300 to 1 in these 10 years [14]. In the Eurolupus cohort of a 1000 SLE patients about 3% were diagnosed after the age of 60 and less than 1% over the age of 70 [11].

Epidemiologic, clinical and laboratory features differ between late onset and adult onset SLE (onset at ages 18–50 years) probably due to immune senescence, hormonal differences and differences in genetic predisposition. Non Caucasian predominance decreases with age of diagnosis [13, 15, 16]. Female to male ratio is less pronounced in some series 2.5–11:1 in late onset lupus compared to 9–14:1 in adult onset SLE, and only 3:1 and 1.1:1 for patients presenting with SLE over the age of 60 and 65 respectively [9, 10, 14, 15, 17, 18]. This supports the role of estrogen in the pathogenesis of SLE.

Diagnosis of SLE in older adult patients is often delayed due to its insidious onset, lower number of cumulative SLE criteria, nonspecific presentation and lack of awareness [13, 19, 20].

Clinically, late onset SLE patients are less likely to have SLE associated major organ involvement, have less mean ACR criteria met at diagnosis and less hospitalization due to disease flare [13, 21]. Pulmonary manifestations are more common in late onset SLE including serositis (odds ratio (OR) 1.31 (95% CI: 1.05–1.65)), pleuritis (OR 1.53 (95% CI: 1.19–1.96)) and interstitial lung disease (ILD) (OR 2.56 (95% CI: 1.27–5.16)), as was shown in a meta-analysis of 1656 patients with late onset SLE [22]. Sicca symptoms are more common in late onset SLE at disease onset, although there is no difference in the prevalence of anti-Ro and anti-La antibodies which are associated with Sjogren syndrome. Therefore sicca symptoms may be a manifestation of increased age and not Sjogren’s disease per se [10, 11, 16, 22, 23].

On the other hand, Lupus related neuropsychiatric manifestations, renal and mucocutaneous manifestations (in particular, malar rash, photosensitivity, livedo reticularis and alopecia) are less common in late onset SLE patients [9, 10, 13, 18, 20, 24].

Comorbidities are higher in patients with late onset SLE and include hypertension, arterial thrombotic events, osteoporosis and hypertriglyceridemia, probably reflecting the association of these manifestations with age or long term medication [12, 13, 16, 20, 23, 25, 26].

Whether the type and frequency of autoantibodies differ between late and early onset lupus is unclear due to inconsistent findings.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.