Abstract
Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease characterized by heterogeneous multisystem involvement and the production of autoantibodies to nuclear and cytoplasmic antigens. Although SLE is most prevalent among women of childbearing age, it may present at any age and in either gender. Clinical manifestations are similar at all ages but incidence and severity differ. Late onset SLE is defined as age of onset of 50 years and above and presents with a frequency of 2.9–18% of adult onset SLE patients. Diagnosis of SLE in older adult patients is often delayed due to its insidious onset, lower number of cumulative SLE criteria, nonspecific presentation and lack of awareness. Pulmonary manifestations such as serositis, pleuritis and interstitial lung disease and Sicca symptoms are more common. Renal, dermatologic and Lupus related neuropsychiatric manifestations are less common in late onset SLE. Comorbidities are higher in patients with late onset SLE and include hypertension, arterial thrombotic events, osteoporosis and hypertriglyceridemia. SLE treatment does not differ in most studies except for lower use of cyclophosphamide. Even though SLE tends to be less active in older patients, age is a factor for poor outcome due to higher damage accrual, therefore survival of patients with late onset SLE is reduced. Most elderly patients with SLE are probably those diagnosed before the age of 65 and even patients diagnosed in childhood, therefore they are subject to long term toxicities of medications. Elderly SLE patients need to be closely followed in order to reduce the occurrence of damage and morbidity from infections, cardiovascular disease and osteoporosis.
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References
Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2019;71(9):1400–12.
Dubois lupus erythematosus and related syndromes. 9th ed. Elsevier. pp. 15–7, 356–8, 391, 623.
Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40:1725.
Tan EM, Cohen AS, Fries JF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982;25:1271–7.
Petri M, Orbai AM, Alrcon GS, et al. Derivation and validation of the SLICC classification criteria for systemic lupus erythematosis. Arthritis Rhem. 2012;64(8):2677–86.
Calixto OJ, Franco JS, Anaya JM. Lupus mimickers. Autoimmun Rev. 2014;13:865–72.
Chasset F, Richez C, Martin T, et al. Rare diseases that mimic SLE (lupus mimickers). Joint Bone Spine. 2019;86:165–71.
Appenzeller S, Pereira DA, Costallat LTL. Greater accrual damage in late onset systemic lupus erythematosis : a long term follow up study. Lupus. 2008;17:1023–8.
Boddaert J, Huong DLT, Amoura Z, et al. Late onset SLE. Medicine. 2004;83(6):348–59.
Catoggio LJ, Soriano ER, Imamura PM, et al. Late onset SLE in Latin Americans: a distinct subgroup? Lupus. 2015;24:788–95.
Cervera R, Khamashta MA, Font J, et al. Systemic lupus erythematosus: clinical and immunologic patterns of disease expression in a cohort of 1,000 patients. Medicine (Baltimore). 1993;72(2):113–24.
Feng X, Zou Y, Pan W, et al. Associations of clinical features and prognosis with age at disease onset in patients with Systemic Lupus Erythematosus. Lupus. 2014;23:327–34.
Lalani S, Pope J, Leon F, Peschken C. Clinical features and prognosis of late onset systemic lupus erythematosus: Results from the 1000 faces of lupus Study. J Rheumatol. 2010;37:38–44.
Pu SJ, Luo SF, Wu YJJ, Cheng HS, Ho HH. The clinical features and prognosis of lupus with disease onset at age 65 and older. Lupus. 2000;9(2):96–100.
Amborse N, Morgan TA, et al. Differences in disease phenotype and severity in SLE across age groups. Lupus. 2016;25:1542–155.
Bertoli AM, Alarcon GS, Calvo-Alen J, et al. Systemic lupus erythematosus in a multiethnic US cohort. Arthritis Rheum. 2006;54(5):1580–7.
Cildag S, Kara Y, Cakir E, et al. Comparison of clinical and laboratory findings in patients with SLE with regard to age of onset. Eur J Med. 2019;51(1):17–21.
Merola JF, Bermas B, Lu B, et al. Clinical manifestations and survival among adults with systemic lupus erythematosus according to age at diagnosis. Lupus. 2014;23(8):778–84.
Stojan G, Petri M. The risk benefit ratio of glucocorticoids in SLE: have things changed over the past 40 years? Curr Treatm Opt Rheumatol. 2017;3(3):164–72.
Tomic-Lucic A, Petrovic R, Radak-Perovic M, et al. Late onset SLE: clinical features, course and prognosis. Clin Rheumatol. 2013;32:1053–8.
Budhoo A, Mody GM, Dubula T, Patel N, Mody PG. Comparison of ethnicity, gender, age of onset and outcome in South Africans with systemic lupus erythematosus. Lupus. 2017;26:438–46.
Medlin JL, Hansen KE, Mccoy SS, Bartels CM. Pulmonary manifestations in late versus early systemic lupus erythematosus: a systematic review and meta-analysis. Semin Arthritis Rheum. 2018;48:198–204.
Choi JH, Park DJ, Kang JH, et al. Comparison of clinical and serological differences among juvenile, adult and late onset SLE in Korean patients. Lupus. 2015;24:1342–9.
Medlin JL, Hansen KE, Fitz SR, Bartels CM. A systematic review and meta-analysis of cutaneous manifestations in late vs early onset SLE. Semin Arthritis Rheum. 2016;45(6):691–7.
Chen YM, Lin CH, Chen HH, et al. Onset age affects mortality and renal outcome of female systemic lupus erythematosus patients: a nationwide population–based study in Taiwan. Rheumatology. 2014;53:180–5.
Sousa S, Goncalves MJ, Ines LS, et al. Clinical features and long term outcomes of SLE: comparative data of childhood, adult and late onset disease in a national register. Rheumatol Int. 2016;36:955–60.
Maddison P, Farewell V, Isenberg D, et al. The rate and pattern of organ damage in late onset systemic lupus eryhtematosus. J Rheumatol. 2002;29:913–7.
Fanouriakis A, Kostopoulou M, Alunno A, et al. Update of the EULAR recommendations for the 2019 management of systemic lupus erythematosus. Ann Rheum Dis. 2019;78:736–45.
Chagas Medeiros MM, Bezerra MC, Braga FN, et al. Clinical and immunological aspects and outcome of a Brazilian cohort of 414 patients with SLE: comparison between childhood onset, adult onset and late onset SLE. Lupus. 2016;25:355–63.
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Peleg, H., Tayer-Shifman, O.E. (2020). Systemic Lupus Erythematosus in Geriatrics. In: Slobodin, G., Shoenfeld, Y. (eds) Rheumatic Disease in Geriatrics . Springer, Cham. https://doi.org/10.1007/978-3-030-44234-7_15
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DOI: https://doi.org/10.1007/978-3-030-44234-7_15
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