Late onset lupus: a clinical and immunological study in a predominantly Chinese population

To compare retrospectively the clinical, laboratory, and immunological features between 50 patients with early and 26 with late onset (> 50 years old) systemic lupus erythematosus (SLE) and to observe differences between our predominantly Chinese and Caucasian patients with late onset SLE.

Case records of 76 consecutive patients (age: 10-73 years) who attended the rheumatology clinic during the study period were reviewed. Chinese constituted 89.4% of the study population.

Compared to the early onset patients, the late onset lupus patients tended to have an insidious onset of disease, lower female predominance and less frequent complaints of fever, alopecia, arthritis, and malar rash at presentation (p < 0.05). Peripheral neuropathy, myalgias, pancytopenia, and elevated liver enzymes were more commonly found in the late onset than in the early onset lupus during followup. Major organ involvement was relatively uncommon in late onset patients. No sex related differences could be demonstrated with respect to the mean age of onset of disease and clinical manifestations. No significant serological differences were detected between the 2 groups. The cause of death in the late onset group was often treatment related.

Differences in disease manifestations were found between the early and late onset lupus patients. The disease expression in our predominantly Chinese elderly patients with lupus also differs from the Caucasian patients. However, the insidious onset and milder disease in the late onset group is in agreement with other studies.