title: Juvenile, adult and late-onset systemic lupus erythematosus: a long term follow-up study from a geographic and ethnically homogeneous population.
abstract: OBJECTIVE
  This paper aims to identify clinical and serological differences, damage accrual and mortality, in juvenile, adult and late-onset SLE.
  
  
  METHODS
  We conducted our study with patients fulfilling SLE classification criteria taken from the Hospital Gregorio Marañon Autoimmune Systemic Rheumatic Diseases' Registry (1986 to 2012). Clinical characteristics, laboratory data and therapies used during the course of the disease were analysed with patients divided into 3 groups: juvenile-onset (≤ 18 years), adult-onset (19-50) and late onset (>50 years).
  
  
  RESULTS
  Four hundred and forty-five patients were included. Renal disease and cutaneous manifestations were more frequent in the juvenile-onset group at disease onset. During follow-up, juvenile-onset group presented a higher incidence of renal disease, malar rash, Raynaud's phenomenon, cutaneous vasculitis, and neuropsychiatric manifestations than the other two groups. Arthritis and lymphopoenia were more frequent in the adult-onset group. Arterial hypertension and neoplasm were more frequent in the late-onset group. Low serum complement, anti-dsDNA, anti-U1RNP and anti-Sm antibodies were more common in the juvenile-onset group. Patients with late-onset SLE had more damage accrual. Thirty-seven patients (8.3%) died during the study. All-cause mortality was significantly higher in the late-onset group. Age at disease onset >50 years was an independent risk factor for damage accrual (OR, 2.2; 95%CI, 1.1-4.6; p=0.029) and mortality (OR, 2.6; 95%CI, 1.1-6.3; p=0.03).
  
  
  CONCLUSIONS
  We found significant differences in clinical and serological profiles between juvenile, adult and late-onset SLE. The most significant of which was a higher prevalence of neuropsychiatric and renal complications as well as different autoantibody signatures for the juvenile-onset group.
authors.affiliation: Department of Rheumatology, Gregorio Marañón General Hospital, Madrid, Spain. juliamartinezbarrio@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Martínez-Barrio
authors.affiliation: Department of Rheumatology, Gregorio Marañón General Hospital, Madrid, Spain.
authors.forename: J G
authors.initials: JG
authors.lastname: Ovalles-Bonilla
authors.affiliation: Department of Rheumatology, Gregorio Marañón General Hospital; and Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: F J
authors.initials: FJ
authors.lastname: López-Longo
authors.affiliation: Department of Rheumatology, Gregorio Marañón General Hospital, Madrid, Spain.
authors.forename: C M
authors.initials: CM
authors.lastname: González
authors.affiliation: Department of Rheumatology, Gregorio Marañón General Hospital, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Montoro
authors.affiliation: Department of Rheumatology, Gregorio Marañón General Hospital, Madrid, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Valor
authors.affiliation: Department of Rheumatology, Gregorio Marañón General Hospital, Madrid, Spain.
authors.forename: L P
authors.initials: LP
authors.lastname: Martínez
authors.affiliation: Department of Rheumatology, Gregorio Marañón General Hospital, Madrid, Spain.
authors.forename: J C
authors.initials: JC
authors.lastname: Nieto
authors.affiliation: Department of Rheumatology, Gregorio Marañón General Hospital, Madrid, Spain.
authors.forename: M C
authors.initials: MC
authors.lastname: Hinojosa-Dávila
authors.affiliation: Department of Rheumatology, Gregorio Marañón General Hospital, Madrid, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Bello
authors.affiliation: Unit of Paediatric Rheumatology, Gregorio Marañón General Hospital, Madrid, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Monteagudo
authors.affiliation: Department of Rheumatology, Gregorio Marañón General Hospital, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Naredo
authors.affiliation: Department of Rheumatology, Gregorio Marañón General Hospital; and Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Carreño
mesh_terms: D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D000368:Aged; D001323:Autoantibodies / Q000097:blood / Q000145:classification; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology; D008180:Lupus Erythematosus, Systemic / Q000145:classification / Q000175:diagnosis / Q000208:ethnology / Q000276:immunology / Q000401:mortality; D008297:Male; D015166:Monitoring, Immunologic / Q000379:methods; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis
chemical_list: D001323:Autoantibodies