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Systemic lupus erythematosus in 50 year olds
I Domenech1, O Aydintug, R Cervera
1Lupus Arthritis Research Unit, Rayne Institute, St Thomas' Hospital, London.
Postgraduate Medical Journal
|June 1, 1992
Summary
Late-onset systemic lupus erythematosus (SLE) in older adults presents distinct initial symptoms like thrombocytopenia and cardiomyopathy, differing from younger patients who more frequently exhibit butterfly rash. Autoimmune thyroiditis is also more common in elderly SLE patients.
Area of Science:
- Rheumatology
- Immunology
- Geriatric Medicine
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical presentations.
- Understanding age-specific differences in SLE onset is crucial for accurate diagnosis and management.
- Late-onset SLE (LO-SLE), defined as onset after age 50, may exhibit unique characteristics compared to childhood or adult-onset SLE.
Purpose of the Study:
- To compare the clinical and serological features of patients with SLE onset after age 50 with those of younger patients.
- To identify specific initial and cumulative symptoms that differentiate elderly SLE patients from younger cohorts.
- To investigate differences in serological markers, such as antibodies to double-stranded DNA, between age groups.
Main Methods:
- Retrospective comparative study involving 15 patients with LO-SLE (onset >50 years) and 232 younger SLE patients.
- Analysis of clinical manifestations including initial presenting symptoms and cumulative symptoms.
- Evaluation of serological markers, including antibodies to double-stranded DNA and presence of autoimmune thyroiditis.
Main Results:
- No significant difference in sex distribution was observed between the elderly and younger SLE groups.
- Elderly patients showed a higher incidence of initial thrombocytopenia, sicca syndrome, and cardiomyopathy, while younger patients more frequently presented with butterfly rash.
- Cumulative symptoms revealed less frequent butterfly rash and livedo reticularis in the elderly, but a significantly increased incidence of sicca syndrome and cardiomyopathy. Antibodies to double-stranded DNA were less frequent in older patients.
Conclusions:
- Late-onset SLE exhibits a distinct clinical profile, characterized by a higher prevalence of sicca syndrome and cardiomyopathy, and a lower frequency of butterfly rash and livedo reticularis compared to younger-onset SLE.
- Thrombocytopenia, sicca syndrome, and cardiomyopathy are important initial manifestations to consider in the elderly population presenting with potential SLE.
- The reduced frequency of antibodies to double-stranded DNA in older patients warrants further investigation into diagnostic approaches for LO-SLE.