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NEW YORK (Reuters Health) Jun 18 - 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.
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