UOC Reumatologia, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy.
UOC Reumatologia, Policlinico AOU e Università degli Studi di Cagliari, Italy.
Clin Exp Rheumatol. 2023 Jan;41(1):145-150. doi: 10.55563/clinexprheumatol/oo5ymg. Epub 2022 Jul 26.
Several studies show that age at onset has an impact on the clinical-serological presentation, comorbidities and disease course of patients with systemic lupus erythematosus (SLE). We evaluated whether, in patients with recent onset SLE, the age at onset correlates with clinical-serological manifestations and with comorbidities.
We analysed 171 patients with a SLE diagnosis obtained within 12 months of diagnosis enrolled in the Early Lupus project. Based on the age of onset of the first disease symptom, they were stratified into 2 groups: early onset (18-45 years) and late onset (>45 years). The analysis was replicated by stratifying patients based on age at diagnosis (fulfillment of ACR classification criteria). Each comparison was made at baseline and at 36 months of follow-up.
Baseline: patients with late onset displayed comorbidities (hypertension, dyslipidemia and osteoporosis) more frequently than early onset group. 11.4% of late onset patients had a malignancy in medical history, not recorded in the early onset cohort. The two groups differed neither in organ involvement (domain BILAG) nor in disease activity (ECLAM). Patients with early onset showed a disease with signs of higher serologic activity (higher frequency of anti-dsDNA positivity and lower mean C3 and C4 levels) and had malar rash more frequently than the late onset group (36.2% vs. 18.2%, p=0.042). Similar results were obtained by stratifying patients by age of diagnosis (18-45 years and >45 years), except for the higher frequency of discoid rash in the group with age at diagnosis >45 years (18% vs. 6.6%, p=0.045). 36 months: the 2 groups of patients independently of the stratification applied did not differ in the accumulation of damage, but showed a different pattern of 8 organ involvement. Musculoskeletal involvement was more frequent both in the late onset group (18.6% vs. 7.3%, p=0.043) and in the group with age at diagnosis >45 years (20.4% vs. 5.9%, p=0.009) compared to their counterparts, while renal involvement was more frequent in the group with age at diagnosis 18-45 years (21.4% vs. 6.1%, p=0.03).A sub analysis at 36 months on patients without hypertension and osteoporosis at enrollment showed that patients with older age at onset had a higher frequency of these comorbidities, compared to their counterparts.
In our cohort, younger disease SLE onset seems to correlate with a more active immunological profile, while late onset with a higher incidence of comorbidities.
多项研究表明，发病年龄与系统性红斑狼疮（SLE）患者的临床-血清学表现、合并症和疾病进程有关。我们评估了在近期发病的 SLE 患者中，发病年龄是否与临床-血清学表现和合并症相关。
我们分析了早期狼疮项目中纳入的 171 名在诊断后 12 个月内获得 SLE 诊断的患者。根据首发症状的发病年龄，将他们分为 2 组：早发组（18-45 岁）和晚发组（>45 岁）。根据诊断时的年龄（符合 ACR 分类标准）对患者进行分层，对每个分组在基线和 36 个月随访时进行比较。
基线：晚发组患者比早发组更常出现合并症（高血压、血脂异常和骨质疏松症）。11.4%的晚发患者有既往病史的恶性肿瘤，而早发组无此记录。两组在器官受累（BILAG 域）或疾病活动度（ECLAM）方面无差异。早发组患者的疾病具有更高的血清学活动迹象（抗 dsDNA 阳性率更高，平均 C3 和 C4 水平更低），且蝶形皮疹更为常见（36.2% vs. 18.2%，p=0.042）。通过按诊断年龄（18-45 岁和>45 岁）对患者进行分层，得到了相似的结果，但在>45 岁的诊断年龄组中，盘状皮疹的发生率更高（18% vs. 6.6%，p=0.045）。36 个月：两组患者在累积损伤方面无差异，但 8 个器官受累的模式不同。无论应用何种分层，晚发组（18.6% vs. 7.3%，p=0.043）和诊断年龄>45 岁组（20.4% vs. 5.9%，p=0.009）的肌肉骨骼受累均更为常见，而诊断年龄 18-45 岁组的肾脏受累更为常见（21.4% vs. 6.1%，p=0.03）。在对入组时无高血压和骨质疏松症的患者进行的 36 个月亚组分析中，发病年龄较大的患者更常发生这些合并症。
在我们的队列中，SLE 发病年龄较小似乎与更活跃的免疫学特征相关，而发病年龄较晚与更高的合并症发生率相关。
