Catoggio L J, Soriano E R, Imamura P M, Wojdyla D, Jacobelli S, Massardo L, Chacón Díaz R, Guibert-Toledano M, Alvarellos A, Saurit V, Manni J A, Pascual-Ramos V, Silva de Sauza A W, Bonfa E, Tavares Brenol J C, Ramirez L A, Barile-Fabris L A, De La Torre I Garcia, Alarcón G S, Pons-Estel B A
Hospital Italiano de Buenos Aires and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
Hospital Italiano de Buenos Aires and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.
Lupus. 2015 Jul;24(8):788-95. doi: 10.1177/0961203314563134. Epub 2014 Dec 11.
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.
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.
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).
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.
在拉丁美洲狼疮研究组（GL ADEL）的系统性红斑狼疮（SLE）患者队列中，研究发生迟发性系统性红斑狼疮（SLE）患者的特征。
纳入在9个拉丁美洲国家的34个中心就诊的病程小于2年的SLE患者。迟发性定义为首次出现SLE相关症状时年龄>50岁。在入组时及病程中（累积发病率）确定临床和实验室表现、活动指数（SLEDAI）和损伤指数（SLICC/ACR - DI）。使用描述性统计和假设检验比较两组患者（<50岁和≥50岁）的特征。进行逻辑回归以检验迟发性狼疮的相关性，并对其他变量进行校正。
在纳入的1480例患者中，102例（6.9%）有迟发性SLE，其中87%为女性。与发病年龄较小的组相比，迟发性SLE患者的随访时间较短（3.6年对4.4年，p<0.002），诊断时间较长（10.1个月对5.8个月，p<0.001）。在老年组中，颧部红斑、光敏性和肾脏受累较少见，而间质性肺病、胸腔积液和干燥症状更常见（p>0.05）。在多变量分析中，迟发性与眼部（OR = 3.66，95%CI = 2.15 - 6.23）、肺部（OR = 2.04，95%CI = 1.01 - 4.11）和心血管（OR = 1.76，95%CI = 1.04 - 2.98）受累的较高几率以及皮肤受累（OR = 0.41，95%CI = 0.21 - 0.80）、累积SLE标准数量（OR = 0.79，95%CI = 0.64 - 0.97）、环磷酰胺使用（OR = 0.47，95%CI = 0.24 - 0.95）和抗RNP抗体（OR = 0.43，95%CI = 0.20 - 0.91）的较低几率独立相关。Cox回归模型显示，老年发病的SLE患者死亡风险高于年轻发病者（OR = 2.61，95%CI = 1.2 - 5.6）。
与年轻发病组相比，拉丁美洲人的迟发性SLE有独特的疾病表现。该疾病似乎较轻，累积SLE标准较低，肾脏/黏膜皮肤受累减少，环磷酰胺使用较少。然而，这些患者有较高的死亡风险以及眼部、肺部和心血管受累风险。
