Systemic lupus erythematosus in later life

This paper presents the clinical features of 14 patients in whom systemic lupus erythematosus (SLE) was diagnosed for the first time after the age of 45 years. The onset was insidious and the diagnosis was delayed in most patients, the mean duration of symptoms before diagnosis being five years. Clinical features in this group of patients differed from classic descriptions of SLE in that there was a high incidence of neuropsychiatric disturbances and low incidence of serositis, while non-specific complaints of fever, weight loss, and malaise were often the only presenting clinical features. Factors associated with disease activity, such as elevated ESR, neutropenia, and thrombocytopenia were less frequency encountered than in younger patients. In 7 of 12 patients immunoglobulins and complement components were detected in basement membrane of normal skin. Diagnosis in this age group is difficult, and it is likely that SLE goes unrecognised in a number of older patients with non-specific complaints.