Late-onset versus early-onset systemic lupus: characteristics and outcome in a national multicentre register (RELESSER)
Anne Riveros-Frutos, Susana Holgado, Arantza Sanvisens Bergé, Irma Casas, Alejandro Olivé, Francisco Javier López-Longo, Jaime Calvo‐Alén, María Galindo-Izquierdo, Antonio Fernández‐Nebro, José María Pego‐Reigosa, Íñigo Rúa‐Figueroa, the RELESSER Group, Jesús García-Villanueva, María Esther Ruiz-Lucea, Francisco J Toyos-Sáenz-de-Miera, José Luís Andreu, C. Bohórquez Heras, Tatiana Cobo‐Ibáñez, Nuria Lozano Rivas, Eva Salgado-Pérez, Jesús Ibáñez Ruán, Celia Erausquin, Eva Tomero, Loreto Horcada, E. Uriarte, Ana Sánchez-Atrio, José Rosas, Carlos Montilla, Manuel Rodríguez–Gómez, Paloma Vela, Ricardo Blanco, Mercedes Freire, Lúcia de Fátima ́da Silva, Elvira Díez Álvarez, Mónica Ibáñez Barceló, Antonio Zea, Javier Narváez, Víctor Martínez‐Taboada, José Luis Marenco, M. Fernández Castro, José Ángel Hernández-Beriaín, M. Gantes, Blanca Hernández‐Cruz, J.J. Pérez-Venegas, Ángela Pecondón, Carlos Marras, Patrícia Carreira, Gema Bonilla, V. Torrente, I. Castellví, Juan Alegre, Mireia Moreno, Enrique Raya, Paloma García de la Peña, Tomás Vázquez, Ángeles Aguirre, Víctor Quevedo
Abstract
OBJECTIVE: The aim of the present study was to describe the demographic, clinical and immunological characteristics of patients with late-onset (≥50 years) SLE vs patients with early-onset SLE (<50 years). METHODS: We performed a cross-sectional retrospective study of 3619 patients from the RELESSER database (National Register of Patients with Systemic Lupus Erythematosus of the Spanish Society of Rheumatology). RESULTS: A total of 565 patients (15.6%) were classified as late-onset SLE and 3054 (84.4%) as early-onset SLE. The male-to-female ratio was 5:1. Mean (s.d.) age at diagnosis in the late-onset group was 57.4 (10.4) years. At diagnosis, patients with late-onset SLE had more comorbid conditions than patients with early-onset SLE; the most frequent was cardiovascular disease (P <0.005). Furthermore, diagnostic delay was longer in patients with late-onset SLE [45.3 (3.1) vs 28.1 (1.0); P <0.001]. Almost all patients with late-onset SLE (98.7%) were Caucasian. Compared with early-onset SLE and after adjustment for time since diagnosis, patients with late-onset SLE more frequently had serositis, major depression, thrombotic events, cardiac involvement and positive lupus anticoagulant values. They were also less frequently prescribed immunosuppressive agents. Mortality was greater in late-onset SLE (14.3% vs 4.7%; P <0.001). CONCLUSION: Late-onset SLE is insidious, with unusual clinical manifestations that can lead to diagnostic errors. Clinical course is generally indolent. Compared with early-onset disease, activity is generally reduced and immunosuppressants are less commonly used. Long-term prospective studies are necessary to determine whether the causes of death are associated with clinical course or with age-associated comorbidities in this population.