title: Evaluation of mortality, disease activity, treatment, clinical and immunological features of adult and late onset systemic Lupus erythematosus.
abstract: OBJECTIVE
  We retrospectively compared disease activity, treatment, clinical and laboratory features, and rate of mortality of 535 SLE patients with adult and late disease onset.
  
  
  METHODS
  patients were divided into two groups based on the onset of the disease before or after 50 years of age. Clinical data were collected from medical reports. Disease activity was measured by ECLAM score. Parameters were compared by χ²-test, Fisher's test, Student's t or the Mann-Whitney test.
  
  
  RESULTS
  Forty patients (7.5%) were included in the late SLE onset group (group A), while 495 (92.5%) in the adult SLE onset group (group B). Sicca symptoms were more frequent in group A (p < 0.0008), while glomerulonephritis (p < 0.0069), reduced C3 (p < 0.0006) and low C3 (p < 0.00002) and C4 levels (p < 0.0006) were more prevalent in group B. Twenty-two deaths (4.3%) were recorded: 14 (2.8%) in group B and 8 (20%) in group A. Deaths were mainly due to infections in group B (28.5%) and cardiovascular events in group A (50%). A lower use of HCQ and LDA were recorded in deceased versus living patients (p < 0.0001 and 0.0166, respectively), while a higher ECLAM score was measured at onset in dead versus living patients (p < 0.048).
  
  
  CONCLUSIONS
  Late onset SLE occurred in 7.5% of patients and it was associated with sicca symptoms. The use of HCQ and LDA is positively correlated with survival. Death in late onset SLE occurred more frequently for cardiovascular involvement. Higher disease activity at onset of the disease might represent a poor prognostic factor for death in adult onset.
authors.affiliation: Spedali Civili, Rheumatology, Brescia, Italy. stefania.cartella@tin.it
authors.forename: Stefania
authors.initials: S
authors.lastname: Cartella
authors.forename: Ilaria
authors.initials: I
authors.lastname: Cavazzana
authors.forename: Angela
authors.initials: A
authors.lastname: Ceribelli
authors.forename: Flora
authors.initials: F
authors.lastname: Inverardi
authors.forename: Angela
authors.initials: A
authors.lastname: Tincani
authors.forename: Franco
authors.initials: F
authors.lastname: Franceschini
mesh_terms: D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies