title: Late-onset systemic lupus erythematosus: clinical features, course, and prognosis.
abstract: There 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. The objective of this study was to evaluate the clinical manifestations, course, treatment, and prognosis of late-onset SLE. Patients who developed SLE after/or at the age of 50 years were considered late-onset SLE and compared to a group of randomly selected patients aged younger than 50 years at the diagnosis, matched for disease duration. Lower frequency of cutaneous manifestations (p = 0.01) and higher frequency of cytopenias (p = 0.02) were registrated at the SLE onset in the late-onset group. Atypical clinical presentation of SLE contributed to a longer delay of diagnosis in late-onset SLE patients (p = 0.005), who fullfiled less American College of Rheumatology criteria at the diagnosis (p = 0.022). Cumulative incidence of clinical manifestations showed lower frequency of cutaneous (p = 0.017), neuropsychiatric manifestations (p = 0.021), lupus nephritis (p = 0.006), and higher frequency of Sjogren's syndrome (p = 0.025) in the late-onset group. Late-onset SLE patients received lower doses of corticosteroid (p = 0.006) and cyclophosphamide (p = 0.001) and had more cyclophosphamide-induced complications (p = 0.005). Higher prevalence of comorbid conditions in the late-onset group (p = 0.025), and higher Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index was noticed (p = 0.018). Despite the less major organ involvement and more benign course of disease, late-onset SLE has poorer prognosis, because of the higher frequency of comorbid conditions and higher organ damage, due to the aging and longer exposition to a classical vascular risk factors.
authors.affiliation: Department of Rheumatology, Internal Clinic, Clinical Centre of Kragujevac, Zmaj Jovina 32, 34 000 Kragujevac, Serbia. sanlusa@ptt.rs
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Tomic-Lucic
authors.forename: Radmila
authors.initials: R
authors.lastname: Petrovic
authors.forename: Marija
authors.initials: M
authors.lastname: Radak-Perovic
authors.forename: Dragan
authors.initials: D
authors.lastname: Milovanovic
authors.forename: Jasmina
authors.initials: J
authors.lastname: Milovanovic
authors.forename: Sandra
authors.initials: S
authors.lastname: Zivanovic
authors.forename: Suzana
authors.initials: S
authors.lastname: Pantovic
authors.forename: Mirjana
authors.initials: M
authors.lastname: Veselinovic
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D017668:Age of Onset; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D008181:Lupus Nephritis / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012859:Sjogren's Syndrome / Q000150:complications / Q000503:physiopathology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D018501:Antirheumatic Agents; D003520:Cyclophosphamide