LATE ONSET SYSTEMIC LUPUS-ERYTHEMATOSUS

The clinical and laboratory features and the natural history of 31 patients with late onset (in the 6th decade or later) systemic lupus erythematosus (SLE) were described. Patients with late onset SLE constituted a distinct subset of the general lupus population that accounted for approximately 12% of the cases. Advanced age modified the expression of SLE in terms of clinical presentation (pleuritis and/or pericarditis were the most common presenting manifestations) and pattern of organ involvement (pulmonary abnormalities were more common; lymphadenopathy, Raynaud''s phenomenon, neuropsychiatric disease, alopecia and skin rash were less common). Because SLE is not usually considered a disease that affects the elderly and because the pattern of SLE in the older age group may differ substantially from that seen in younger patients, there is often a delay in diagnosis (median of 10 mo., with a delay of over 1 yr in 32% of patients) or an incorrect diagnosis is initially made (55% of patients). Due to the high incidence of steroid complications in older patients (40% in this series) and because these patients with SLE have a relatively good prognosis (5 yr survival of 92.3%; 9 yr survival of 83.1%), therapy should be more conservative in late onset SLE.