Appenzeller S, Pereira D A, Costallat L T L
Department of Internal Medicine, Rheumatology Unit, State University of Campinas, Campinas, Brazil.
Lupus. 2008 Nov;17(11):1023-8. doi: 10.1177/0961203308089695.
The main objective of this study was to evaluate the clinical differences and the pattern and extent of organ damage in late-onset systemic lupus erythematosus (SLE). A nested case-control study was performed from patients with SLE followed in the Rheumatology Unit of the State University of Campinas between 1974 and 2005. Patients who developed SLE after the age of 49 were considered late-onset SLE. SLE patients with age <49 years, matched for sex, ethnicity, disease duration and organ damage at study entry were randomly chosen to compose the control group. Baseline and cumulative clinical manifestations, laboratory data, SLE disease activity index (SLEDAI), Systemic Lupus International Collaborating Clinics/American College of Rheumatology-damage index (SDI) and mortality were compared between groups. At diagnosis and follow-up, late-onset group had lower SLEDAI scores when compared with younger age onset. Clinically, they presented less frequently arthritis (P = 0.0002) and malar rash (P = 0.02) and more frequently Raynaud's phenomenon (P = 0.002) and arterial hypertension (P = 0.02) when compared with young onset at diagnosis. Late-onset SLE received lower total corticosteroid dose (P < 0.001) and less frequently cyclophosphamide (P = 0.01). During the study period, late-onset SLE had always lower SLEDAI scores (P = 0.001). At study endpoint, late-onset SLE patients had significantly higher SDI scores (P = 0.001) and a higher mortality rate when compared with younger onset group (P < 0.01). In conclusion, late-onset SLE is milder on presentation and during course of disease, but patients have more organ damage and a higher rate of mortality than young onset SLE. Patients with late onset should be followed with close monitoring and early identification of complications is mandatory in this subgroup of patients with SLE.
本研究的主要目的是评估晚发性系统性红斑狼疮（SLE）的临床差异以及器官损害的模式和程度。对1974年至2005年期间在坎皮纳斯州立大学风湿病科随访的SLE患者进行了一项巢式病例对照研究。49岁以后发病的患者被视为晚发性SLE。随机选择年龄<49岁、在研究入组时性别、种族、病程和器官损害相匹配的SLE患者组成对照组。比较两组之间的基线和累积临床表现、实验室数据、SLE疾病活动指数（SLEDAI）、系统性红斑狼疮国际协作临床/美国风湿病学会损伤指数（SDI）和死亡率。在诊断和随访时，与年轻发病组相比，晚发性组的SLEDAI评分较低。临床上，与诊断时的年轻发病组相比，他们关节炎（P = 0.0002）和颊部皮疹（P = 0.02）的发生率较低，雷诺现象（P = 0.002）和动脉高血压（P = 0.02）的发生率较高。晚发性SLE接受的总皮质类固醇剂量较低（P < 0.001），环磷酰胺的使用频率较低（P = 0.01）。在研究期间，晚发性SLE的SLEDAI评分始终较低（P = 0.001）。在研究终点，与年轻发病组相比，晚发性SLE患者的SDI评分显著更高（P = 0.001），死亡率更高（P < 0.01）。总之，晚发性SLE在疾病表现和病程中较轻，但与年轻发病的SLE相比，患者有更多的器官损害和更高的死亡率。对于晚发性患者应密切监测，在这一SLE亚组患者中必须早期识别并发症。
