Ho C T, Mok C C, Lau C S, Wong R W
Department of Medicine, Queen Mary Hospital, Hong Kong, SAR, People's Republic of China.
Ann Rheum Dis. 1998 Jul;57(7):437-40. doi: 10.1136/ard.57.7.437.
Systemic lupus erythematosus (SLE) is a multisystem disorder that predominately affects women of the reproductive age. Onset of the disease beyond the age of 50 years is unusual. This study was undertaken to compare retrospectively the clinical and laboratory features between early and late onset (onset of disease beyond the age of 50 years) SLE patients in a Chinese population.
Case records of all SLE patients who attended our rheumatology clinics between 1971 and 1997 were reviewed. Patients with a disease onset beyond the age of 50 years were identified. One hundred consecutive SLE patients who had their disease onset before the age of 50 were recruited as controls. The presenting clinical features, autoantibody profile, number of major organs involved, number of major relapses, and the use of cytotoxic agents in the two groups of patients were obtained and compared.
25 patients with late onset SLE were identified. All the female patients in the late onset group were postmenopausal. The female to male ratio was 3.2 to 1, compared with 13.3 to 1 in the control group (p < 0.02). Both groups had a comparable duration of disease. There were no significant differences in the presenting features between the two groups except for a lower prevalence of malar rash (24% v 86%, p < 0.0001) and a higher prevalence of rheumatoid factor (32% v 1%, p < 0.0001) in the late onset patients. On subsequent visits, the late onset group had a lower prevalence of lupus nephritis (4% v 51%, p < 0.001), fewer major organs involved (mean number of major organs involved; 0.3 v 0.9, p < 0.02), fewer major relapses (mean number of major relapses/patient; 0.08 v 0.47, p < 0.002, number of major relapses/patient year; 0.009 v 0.12, p < 0.001), and required fewer cytotoxic agents for disease control (percentage of patients on cytotoxic agents; 32% v 79%, p < 0.002).
Late onset SLE in Chinese tends to run a more benign course with fewer major organ involvement and fewer major relapses. The significantly higher incidence of male sex in late onset SLE and the milder disease course in the postmenopausal female patients suggest that oestrogen status may influence disease activity.
系统性红斑狼疮（SLE）是一种多系统疾病，主要影响育龄女性。50岁以后发病并不常见。本研究旨在回顾性比较中国人群中早发性和晚发性（50岁以后发病）SLE患者的临床和实验室特征。
回顾了1971年至1997年间在我们风湿科门诊就诊的所有SLE患者的病历。确定发病年龄超过50岁的患者。招募100例发病年龄在50岁之前的连续SLE患者作为对照。获取并比较两组患者的临床表现、自身抗体谱、主要受累器官数量、主要复发次数以及细胞毒药物的使用情况。
确定了25例晚发性SLE患者。晚发性组的所有女性患者均已绝经。晚发性组的男女比例为3.2比1，而对照组为13.3比1（p<0.02）。两组的病程相当。两组的临床表现除晚发性患者中颧部红斑的患病率较低（24%对86%，p<0.0001）和类风湿因子的患病率较高（32%对1%，p<0.0001）外，无显著差异。在随后的随访中，晚发性组狼疮肾炎的患病率较低（4%对51%，p<0.001），主要受累器官较少（主要受累器官的平均数量；0.
