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Lupus. 2015 Jul;24(8):788-95. doi: 10.1177/0961203314563134. Epub 2014 Dec 11.

Late-onset systemic lupus erythematosus in Latin Americans: a distinct subgroup?

Author information

1
Hospital Italiano de Buenos Aires and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina Luis.catoggio@hospitalitaliano.org.ar.
2
Hospital Italiano de Buenos Aires and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.
3
Universidad Nacional de Rosario, Rosario, Argentina.
4
Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
5
Hospital Universitario de Caracas, Caracas, Venezuela.
6
Centro de Investigaciones Médico Quirúrgicas, Habana, Cuba.
7
Servicio de Reumatología, Hospital Privado, Centro Médico de Córdoba, Córdoba, Argentina.
8
Instituto de Investigaciones Médicas "Alfredo Lanari", Buenos Aires, Argentina.
9
Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México Distrito Federal, Mexico.
10
Universidade Federal de São Paulo, São Paulo, Brazil.
11
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
12
Hospital das Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
13
Universidad de Antioquia, Hospital Universitario "Fundación San Vicente", Medellín, Colombia.
14
Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México Distrito Federal, Mexico.
15
Hospital General de Occidente de la Secretaría de Salud, Guadalajara, Jalisco, Mexico.
16
Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA.
17
Hospital Provincial de Rosario, Rosario, Argentina.

Abstract

OBJECTIVE:

To examine the characteristics of patients who developed late onset systemic lupus erythematosus (SLE) in the GLADEL (Grupo Latino Americano de Estudio del Lupus) cohort of patients with SLE.

METHODS:

Patients with SLE of less than two years of disease duration, seen at 34 centers of nine Latin American countries, were included. Late-onset was defined as >50 years of age at time of first SLE-related symptom. Clinical and laboratory manifestations, activity index (SLEDAI), and damage index (SLICC/ACR- DI) were ascertained at time of entry and during the course (cumulative incidence). Features were compared between the two patient groups (<50 and ≥50) using descriptive statistics and hypothesis tests. Logistic regression was performed to examine the association of late-onset lupus, adjusting for other variables.

RESULTS:

Of the 1480 patients included, 102 patients (6.9 %) had late-onset SLE, 87% of which were female. Patients with late-onset SLE had a shorter follow-up (3.6 vs. 4.4 years, p < 0.002) and a longer time to diagnosis (10.1 vs. 5.8 months, p < 0.001) compared to the younger onset group. Malar rash, photosensitivity, and renal involvement were less prevalent while interstitial lung disease, pleural effusions, and sicca symptoms were more frequent in the older age group (p > 0.05). In multivariable analysis, late onset was independently associated with higher odds of ocular (OR = 3.66, 95% CI = 2.15-6.23), pulmonary (OR = 2.04, 95% CI = 1.01-4.11), and cardiovascular (OR = 1.76, 95% CI = 1.04-2.98) involvement and lower odds of cutaneous involvement (OR = 0.41, 95% CI = 0.21-0.80), number of cumulative SLE criteria (OR = 0.79, 95% CI = 0.64-0.97), use of cyclophosphamide (OR = 0.47, 95% CI = 0.24-0.95), and anti-RNP antibodies (OR = 0.43, 95% CI = 0.20-0.91). A Cox regression model revealed a higher risk of dying in older onset than the younger-onset SLE (OR = 2.61, 95% CI = 1.2-5.6).

CONCLUSION:

Late-onset SLE in Latin Americans had a distinct disease expression compared to the younger-onset group. The disease seems to be mild with lower cumulative SLE criteria, reduced renal/mucocutaneous involvements, and less use of cyclophosphamide. Nevertheless, these patients have a higher risk of death and of ocular, pulmonary, and cardiovascular involvements.

KEYWORDS:

Systemic lupus erythematosus; anti-DNA antibodies; cardiovascular disease; hematologic changes; musculoskeletal disease; renal lupus

PMID:
25504653
DOI:
10.1177/0961203314563134
[Indexed for MEDLINE]

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