Department of Internal Medicine, Centro Hospitalar Universitário de Santo António, Porto, Portugal.
Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal.
Clin Exp Rheumatol. 2024 Jul;42(7):1480-1486. doi: 10.55563/clinexprheumatol/jgsyos. Epub 2024 Mar 19.
Age has a significant impact on systemic lupus erythematosus (SLE). However, data on very late-onset SLE (vlSLE) are scarce. We have compared the clinical and serological features of vlSLE patients with younger-onset patients.
We assessed the clinical and laboratory data of all patients fulfilling SLE classification criteria evaluated at a university hospital from 1978 to 2023. Patients were divided into 4 groups according to age at diagnosis: juvenile SLE (jSLE <8 years); adult SLE (aSLE 18-49 years); late SLE (lSLE 50-59 years); vlSLE (≥60 years).
845 patients were enrolled. The jSLE, aSLE, lSLE, and vlSLE groups included 153, 630, 47, and 15 patients, respectively. The vlSLE group tended to have a lower female-to-male ratio (4:1; p=0.282), was mainly Caucasian (93.3%; p<0.001), and had the lowest survival time (20.3 years; p<0.001). vlSLE patients had the lowest prevalence of positive anti-dsDNA antibodies (26.7%; p=0.010) and low C3 levels (13.3%; p<0.001). Although arthritis was less common among vlSLE patients (73.3%; p=0.043), they more commonly developed Sjögren's syndrome (SS 33.3%; p<0.001) and rheumatoid arthritis (RA 13.3%; p<0.001). Infections and malignancy were the main causes of death.
Compared with younger patients, in vlSLE, female predominance is less pronounced. Arthritis, anti-dsDNA antibodies and low C3 levels are less frequent. SS and RA are more common. Despite lower disease activity, vlSLE patients have the lowest survival rate. While uncommon, SLE should not be excluded as a possible diagnosis in the elderly.
年龄对系统性红斑狼疮（SLE）有显著影响。然而，关于极晚发性 SLE（vlSLE）的数据很少。我们比较了 vlSLE 患者与年轻发病患者的临床和血清学特征。
我们评估了 1978 年至 2023 年在一家大学医院评估的符合 SLE 分类标准的所有患者的临床和实验室数据。根据诊断时的年龄，患者分为 4 组：幼年 SLE（jSLE<8 岁）；成人 SLE（aSLE 18-49 岁）；晚发性 SLE（lSLE 50-59 岁）；极晚发性 SLE（vlSLE≥60 岁）。
共纳入 845 例患者。jSLE、aSLE、lSLE 和 vlSLE 组分别纳入 153、630、47 和 15 例患者。vlSLE 组女性与男性比例较低（4:1；p=0.282），主要为白种人（93.3%；p<0.001），生存时间最短（20.3 年；p<0.001）。vlSLE 患者抗 dsDNA 抗体阳性率（26.7%；p=0.010）和低 C3 水平（13.3%；p<0.001）最低。尽管 vlSLE 患者关节炎较少（73.3%；p=0.043），但他们更常发生干燥综合征（SS 33.3%；p<0.001）和类风湿关节炎（RA 13.3%；p<0.001）。感染和恶性肿瘤是死亡的主要原因。
与年轻患者相比，vlSLE 中女性优势不明显。关节炎、抗 dsDNA 抗体和低 C3 水平较少见。SS 和 RA 更常见。尽管疾病活动度较低，但 vlSLE 患者的生存率最低。尽管不常见，但 SLE 不应排除作为老年人的可能诊断。
