Late-Onset of SLE May Not be Milder than Early-Onset Disease

Late-Onset SLE May Not Be Milder Than Early-Onset Disease

NEW YORK (Reuters Health) Jun 18, 2002 - Late-onset systemic lupus erythematosus (SLE) is associated with a greater occurrence of organ damage compared with early onset SLE, report investigators from the Systemic Lupus International Collaborating Clinics (SLICC). This finding belies previous reports that late-onset disease is milder and associated with a better prognosis.

Dr. Peter J. Maddison, of Ysbyty Gwynedd in Bangor, Wales, and associates prospectively followed 86 patients diagnosed with SLE after age 54 and 155 patients diagnosed before age 40. SDI (SLICC/American College of Rheumatology Damage Index) scores were estimated for subjects at 1 year and 5 years after their diagnosis.

SDI scores were significantly higher in the older group at 1 year and at 5 years (p<0.001 for both), although the maximum score achieved was only '8' out of a theoretical maximum of 47. At 5 years, SDI scores averaged 1.6 and 0.9 in the older and younger cohorts, respectively, according to the investigators' report in the Journal of Rheumatology for May.

The frequency at which damage occurred to the skin, kidneys, central nervous system, lungs, and gastrointestinal tract were similar in the two groups. However, the late-onset patients had more than 14 times the risk of cardiovascular disease and more than 9 times the risk of ocular involvement compared with their younger counterparts. Risk of malignancy was elevated by seven times, while that for musculoskeletal damage was more than doubled in the late-onset patients.

The researchers note that previous studies indicating a worse outcome among early-onset patients were conducted in the absence of validated disease activity measures.

They believe the findings are valid, given that SLE is known to accelerate coronary artery disease, and that the risk of CAD is increased by five- to eight-fold in women with SLE. However, they concede that the results may simply indicate the increased prevalence of age-related comorbidities in the older cohort.

J Rheumatol 2002;29:913-917.

Reuters Health Information 2002.