Division of Rheumatology & Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Research Service, Tennessee Valley Healthcare System Veterans Administration Medical Center, Nashville, TN, USA.
Lupus. 2024 Apr;33(5):525-531. doi: 10.1177/09612033241238052. Epub 2024 Mar 7.
Late-onset systemic lupus erythematosus (LO-SLE) is defined as SLE diagnosed at age 50 years or later. Current studies on LO-SLE are small and have conflicting results. Using a large, electronic health record (EHR)-based cohort of SLE individuals, we compared demographics, disease characteristics, SLE-specific antibodies, and medication prescribing practices in LO ( = 123) vs. NLO-SLE ( = 402) individuals. The median age (interquartile range) at SLE diagnosis was 60 (56-67) years for LO-SLE and 28 (20-38) years for NLO-SLE. Both groups were predominantly female (85% vs. 91%, = 0.10). LO-SLE individuals were more likely to be White than NLO-SLE individuals (74% vs. 60%, = 0.005) and less likely to have positive dsDNA (39% vs. 58%, = 0.001) and RNP (17% vs. 32%, = 0.02) with no differences in Smith, SSA, and SSB. Autoantibody positivity declined with increasing age at SLE diagnosis. LO-SLE individuals were less likely to develop SLE nephritis (9% vs. 29%, < 0.001) and less likely to be prescribed multiple classes of SLE medications including antimalarials (90% vs. 95%, = 0.04), azathioprine (17% vs. 31%, = 0.002), mycophenolate mofetil (12% vs. 38%, < 0.001), and belimumab (2% vs. 8%, = 0.02). LO-SLE individuals may be less likely to fit an expected course for SLE with less frequent positive autoantibodies at diagnosis and lower rates of nephritis, even after adjusting for race. Understanding how age impacts SLE disease presentation could help reduce diagnostic delays in SLE.
迟发性系统性红斑狼疮（LO-SLE）定义为 50 岁或以上确诊的 SLE。目前关于 LO-SLE 的研究规模较小，结果存在争议。本研究利用基于电子健康记录（EHR）的大型 SLE 个体队列，比较了 LO（n=123）与 NLO-SLE（n=402）个体的人口统计学、疾病特征、SLE 特异性抗体和药物处方实践。LO-SLE 患者 SLE 诊断的中位年龄（四分位距）为 60（56-67）岁，NLO-SLE 为 28（20-38）岁。两组均以女性为主（85%比 91%，P=0.10）。LO-SLE 患者白人比例高于 NLO-SLE 患者（74%比 60%，P=0.005），dsDNA 阳性率（39%比 58%，P=0.001）和 RNP 阳性率（17%比 32%，P=0.02）较低，而 Smith、SSA 和 SSB 抗体阳性率无差异。随着 SLE 诊断年龄的增加，自身抗体阳性率下降。LO-SLE 患者 SLE 肾炎的发生率较低（9%比 29%，P<0.001），更不可能同时使用多种 SLE 药物，包括抗疟药（90%比 95%，P=0.04）、硫唑嘌呤（17%比 31%，P=0.002）、霉酚酸酯（12%比 38%，P<0.001）和贝利尤单抗（2%比 8%，P=0.02）。即使在调整种族因素后，LO-SLE 患者的自身抗体阳性率在诊断时较低，肾炎发生率也较低，其 SLE 发病模式可能不符合预期。了解年龄如何影响 SLE 疾病表现有助于减少 SLE 的诊断延迟。
