title: Late-onset systemic lupus erythematosus in Latin Americans: a distinct subgroup?
abstract: OBJECTIVE
  To examine the characteristics of patients who developed late onset systemic lupus erythematosus (SLE) in the GLADEL (Grupo Latino Americano de Estudio del Lupus) cohort of patients with SLE.
  
  
  METHODS
  Patients with SLE of less than two years of disease duration, seen at 34 centers of nine Latin American countries, were included. Late-onset was defined as >50 years of age at time of first SLE-related symptom. Clinical and laboratory manifestations, activity index (SLEDAI), and damage index (SLICC/ACR- DI) were ascertained at time of entry and during the course (cumulative incidence). Features were compared between the two patient groups (<50 and ≥50) using descriptive statistics and hypothesis tests. Logistic regression was performed to examine the association of late-onset lupus, adjusting for other variables.
  
  
  RESULTS
  Of the 1480 patients included, 102 patients (6.9 %) had late-onset SLE, 87% of which were female. Patients with late-onset SLE had a shorter follow-up (3.6 vs. 4.4 years, p < 0.002) and a longer time to diagnosis (10.1 vs. 5.8 months, p < 0.001) compared to the younger onset group. Malar rash, photosensitivity, and renal involvement were less prevalent while interstitial lung disease, pleural effusions, and sicca symptoms were more frequent in the older age group (p > 0.05). In multivariable analysis, late onset was independently associated with higher odds of ocular (OR = 3.66, 95% CI = 2.15-6.23), pulmonary (OR = 2.04, 95% CI = 1.01-4.11), and cardiovascular (OR = 1.76, 95% CI = 1.04-2.98) involvement and lower odds of cutaneous involvement (OR = 0.41, 95% CI = 0.21-0.80), number of cumulative SLE criteria (OR = 0.79, 95% CI = 0.64-0.97), use of cyclophosphamide (OR = 0.47, 95% CI = 0.24-0.95), and anti-RNP antibodies (OR = 0.43, 95% CI = 0.20-0.91). A Cox regression model revealed a higher risk of dying in older onset than the younger-onset SLE (OR = 2.61, 95% CI = 1.2-5.6).
  
  
  CONCLUSIONS
  Late-onset SLE in Latin Americans had a distinct disease expression compared to the younger-onset group. The disease seems to be mild with lower cumulative SLE criteria, reduced renal/mucocutaneous involvements, and less use of cyclophosphamide. Nevertheless, these patients have a higher risk of death and of ocular, pulmonary, and cardiovascular involvements.
authors.affiliation: Hospital Italiano de Buenos Aires and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina Luis.catoggio@hospitalitaliano.org.ar.
authors.forename: L J
authors.initials: LJ
authors.lastname: Catoggio
authors.affiliation: Hospital Italiano de Buenos Aires and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.
authors.forename: E R
authors.initials: ER
authors.lastname: Soriano
authors.affiliation: Hospital Italiano de Buenos Aires and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.
authors.forename: P M
authors.initials: PM
authors.lastname: Imamura
authors.affiliation: Universidad Nacional de Rosario, Rosario, Argentina.
authors.forename: D
authors.initials: D
authors.lastname: Wojdyla
authors.affiliation: Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: S
authors.initials: S
authors.lastname: Jacobelli
authors.affiliation: Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: L
authors.initials: L
authors.lastname: Massardo
authors.affiliation: Hospital Universitario de Caracas, Caracas, Venezuela.
authors.forename: R
authors.initials: R
authors.lastname: Chacón Díaz
authors.affiliation: Centro de Investigaciones Médico Quirúrgicas, Habana, Cuba.
authors.forename: M
authors.initials: M
authors.lastname: Guibert-Toledano
authors.affiliation: Servicio de Reumatología, Hospital Privado, Centro Médico de Córdoba, Córdoba, Argentina.
authors.forename: A
authors.initials: A
authors.lastname: Alvarellos
authors.affiliation: Servicio de Reumatología, Hospital Privado, Centro Médico de Córdoba, Córdoba, Argentina.
authors.forename: V
authors.initials: V
authors.lastname: Saurit
authors.affiliation: Instituto de Investigaciones Médicas "Alfredo Lanari", Buenos Aires, Argentina.
authors.forename: J A
authors.initials: JA
authors.lastname: Manni
authors.affiliation: Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México Distrito Federal, Mexico.
authors.forename: V
authors.initials: V
authors.lastname: Pascual-Ramos
authors.affiliation: Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: A W
authors.initials: AW
authors.lastname: Silva de Sauza
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: E
authors.initials: E
authors.lastname: Bonfa
authors.affiliation: Hospital das Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: J C
authors.initials: JC
authors.lastname: Tavares Brenol
authors.affiliation: Universidad de Antioquia, Hospital Universitario "Fundación San Vicente", Medellín, Colombia.
authors.forename: L A
authors.initials: LA
authors.lastname: Ramirez
authors.affiliation: Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México Distrito Federal, Mexico.
authors.forename: L A
authors.initials: LA
authors.lastname: Barile-Fabris
authors.affiliation: Hospital General de Occidente de la Secretaría de Salud, Guadalajara, Jalisco, Mexico.
authors.forename: I Garcia
authors.initials: IG
authors.lastname: De La Torre
authors.affiliation: Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: G S
authors.initials: GS
authors.lastname: Alarcón
authors.affiliation: Hospital Provincial de Rosario, Rosario, Argentina.
authors.forename: B A
authors.initials: BA
authors.lastname: Pons-Estel
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D003520:Cyclophosphamide / Q000627:therapeutic use*; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy* / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide
keywords: Systemic lupus erythematosus; anti-DNA antibodies; cardiovascular disease; hematologic changes; musculoskeletal disease; renal lupus