Is late-onset lupus a “wolf in sheep's clothing”?

Late-onset systemic lupus erythematosus (SLE), often considered to have a benign disease course, actually involves greater disease activity and comorbidities than early-onset SLE. Differences in disease activity may be associated with an interaction between the SLE and age.

Lalani and colleagues compared the course of SLE in 1528 persons from the 1000 Faces of Lupus Study. The 10.5% of participants who had late-onset lupus (onset at 50 years or older) were compared with early-onset controls.

The groups differed significantly. The younger group received a diagnosis sooner (2.82 vs 4.83 years), had lengthier illness, and fulfilled more American College of Rheumatology criteria for SLE. They also differed serologically and clinically, having higher incidences of positive anti-Smith autoantibody, ribonucleoprotein, hypocomplementemia, nephritis, malar rash, and cytopenia. Younger persons had severe renal disease and older persons had a higher comorbidity index, reflecting more congestive heart failure and peptic ulcer disease. Mean SLE activity and disease-induced damage were more significant in older persons; lupus flares, fatigue, sun rash, dyspnea, paresthesia, and muscle weakness were more common.

The authors noted that as an increasing number of persons survive longer, there will be more cases of late-onset SLE and a need for physicians to become more aware this possibility.