Comparison of clinical features, disease activity, treatment and outcomes between late-onset and early-onset patients with systemic lupus erythematosus. A sex- and year at diagnosis-matched controlled study
Abstract Background Several studies have compared the clinical features and outcomes of late- and early-onset systemic lupus erythematosus (SLE) patients. However, these previous studies were uncontrolled. The current study aimed to compare late- and early-onset SLE patients while controlling for se...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-05-01
|
| Series: | Advances in Rheumatology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42358-023-00297-0 |
| _version_ | 1827952490750935040 |
|---|---|
| author | Jarukit Mongkolchaiarunya Antika Wongthanee Nuntana Kasitanon Worawit Louthrenoo |
| author_facet | Jarukit Mongkolchaiarunya Antika Wongthanee Nuntana Kasitanon Worawit Louthrenoo |
| author_sort | Jarukit Mongkolchaiarunya |
| collection | DOAJ |
| description | Abstract Background Several studies have compared the clinical features and outcomes of late- and early-onset systemic lupus erythematosus (SLE) patients. However, these previous studies were uncontrolled. The current study aimed to compare late- and early-onset SLE patients while controlling for sex and year at diagnosis (± 1 year). Methods The medical records of SLE patients in a lupus cohort from January 1994 to June 2020 were reviewed. Late-onset patients were identified as those with an age at diagnosis ≥ 50 years. The early-onset patients (age at diagnosis < 50 years) were matched by sex and year at diagnosis with the late-onset patients at a ratio of 2:1. Clinical manifestations, disease activity (mSLEDAI-2K), organ damage scores, treatment, and mortality were compared between the two groups. Results The study comprised 62 and 124 late- and early-onset patients, respectively, with a mean follow-up duration of 5 years. At disease onset, when comparing the early-onset patients with the late-onset patients, the latter group had a higher prevalence rate of serositis (37.0% vs. 14.5%, p < 0.001) and hemolytic anemia (50.0% vs. 33.9%, p = 0.034) but lower prevalence rate of malar rash (14.5% vs. 37.1%, p = 0.001), arthritis (41.9% vs. 62.1%, p = 0.009), leukopenia (32.3% vs. 50.0%, p = 0.022) and lymphopenia (50.0% vs. 66.1%, p = 0.034). The groups had similar SLE disease activity (7.41 vs. 7.50), but the late-onset group had higher organ damage scores (0.37 vs. 0.02, p < 0.001). The rates of treatment with corticosteroids, antimalarial drugs, or immunosuppressive drugs were not different. At their last visit, the late-onset patients still had the same pattern of clinically significant differences except for arthritis; additionally, the late-onset group had a lower rate of nephritis (53.2% vs. 74.2%, p = 0.008). They also had a lower level of disease activity (0.41 vs. 0.57, p = 0.006) and received fewer antimalarials (67.7% vs. 85.5%, p = 0.023) and immunosuppressive drugs (61.3% vs. 78.2%, p = 0.044), but they had higher organ damage scores (1.37 vs. 0.47, p < 0.001) and higher mortality rates/100-person year (3.2 vs. 1.1, p = 0.015). After adjusting for disease duration and baseline clinical variables, the late-onset patients only had lower rate of nephritis (p = 0.002), but still received fewer immunosuppressive drugs (p = 0.005) and had a higher mortality rate (p = 0.037). Conclusions In this sex- and year at diagnosis-matched controlled study, after adjusting for disease duration and baseline clinical variables, the late-onset SLE patients had less renal involvement and received less aggressive treatment, but had a higher mortality rate than the early-onset patients. |
| first_indexed | 2024-04-09T13:59:30Z |
| format | Article |
| id | doaj.art-f85453651172495f944c9f01391e3a56 |
| institution | Directory Open Access Journal |
| issn | 2523-3106 |
| language | English |
| last_indexed | 2024-04-09T13:59:30Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Advances in Rheumatology |
| spelling | doaj.art-f85453651172495f944c9f01391e3a562023-05-07T11:27:37ZengBMCAdvances in Rheumatology2523-31062023-05-0163111010.1186/s42358-023-00297-0Comparison of clinical features, disease activity, treatment and outcomes between late-onset and early-onset patients with systemic lupus erythematosus. A sex- and year at diagnosis-matched controlled studyJarukit Mongkolchaiarunya0Antika Wongthanee1Nuntana Kasitanon2Worawit Louthrenoo3Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai UniversityDepartment of Internal Medicine, Faculty of Medicine, Chiang Mai UniversityDivision of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai UniversityDivision of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai UniversityAbstract Background Several studies have compared the clinical features and outcomes of late- and early-onset systemic lupus erythematosus (SLE) patients. However, these previous studies were uncontrolled. The current study aimed to compare late- and early-onset SLE patients while controlling for sex and year at diagnosis (± 1 year). Methods The medical records of SLE patients in a lupus cohort from January 1994 to June 2020 were reviewed. Late-onset patients were identified as those with an age at diagnosis ≥ 50 years. The early-onset patients (age at diagnosis < 50 years) were matched by sex and year at diagnosis with the late-onset patients at a ratio of 2:1. Clinical manifestations, disease activity (mSLEDAI-2K), organ damage scores, treatment, and mortality were compared between the two groups. Results The study comprised 62 and 124 late- and early-onset patients, respectively, with a mean follow-up duration of 5 years. At disease onset, when comparing the early-onset patients with the late-onset patients, the latter group had a higher prevalence rate of serositis (37.0% vs. 14.5%, p < 0.001) and hemolytic anemia (50.0% vs. 33.9%, p = 0.034) but lower prevalence rate of malar rash (14.5% vs. 37.1%, p = 0.001), arthritis (41.9% vs. 62.1%, p = 0.009), leukopenia (32.3% vs. 50.0%, p = 0.022) and lymphopenia (50.0% vs. 66.1%, p = 0.034). The groups had similar SLE disease activity (7.41 vs. 7.50), but the late-onset group had higher organ damage scores (0.37 vs. 0.02, p < 0.001). The rates of treatment with corticosteroids, antimalarial drugs, or immunosuppressive drugs were not different. At their last visit, the late-onset patients still had the same pattern of clinically significant differences except for arthritis; additionally, the late-onset group had a lower rate of nephritis (53.2% vs. 74.2%, p = 0.008). They also had a lower level of disease activity (0.41 vs. 0.57, p = 0.006) and received fewer antimalarials (67.7% vs. 85.5%, p = 0.023) and immunosuppressive drugs (61.3% vs. 78.2%, p = 0.044), but they had higher organ damage scores (1.37 vs. 0.47, p < 0.001) and higher mortality rates/100-person year (3.2 vs. 1.1, p = 0.015). After adjusting for disease duration and baseline clinical variables, the late-onset patients only had lower rate of nephritis (p = 0.002), but still received fewer immunosuppressive drugs (p = 0.005) and had a higher mortality rate (p = 0.037). Conclusions In this sex- and year at diagnosis-matched controlled study, after adjusting for disease duration and baseline clinical variables, the late-onset SLE patients had less renal involvement and received less aggressive treatment, but had a higher mortality rate than the early-onset patients.https://doi.org/10.1186/s42358-023-00297-0Systemic lupus erythematosusLate-onsetOutcomesClinical manifestationsMortality |
| spellingShingle | Jarukit Mongkolchaiarunya Antika Wongthanee Nuntana Kasitanon Worawit Louthrenoo Comparison of clinical features, disease activity, treatment and outcomes between late-onset and early-onset patients with systemic lupus erythematosus. A sex- and year at diagnosis-matched controlled study Advances in Rheumatology Systemic lupus erythematosus Late-onset Outcomes Clinical manifestations Mortality |
| title | Comparison of clinical features, disease activity, treatment and outcomes between late-onset and early-onset patients with systemic lupus erythematosus. A sex- and year at diagnosis-matched controlled study |
| title_full | Comparison of clinical features, disease activity, treatment and outcomes between late-onset and early-onset patients with systemic lupus erythematosus. A sex- and year at diagnosis-matched controlled study |
| title_fullStr | Comparison of clinical features, disease activity, treatment and outcomes between late-onset and early-onset patients with systemic lupus erythematosus. A sex- and year at diagnosis-matched controlled study |
| title_full_unstemmed | Comparison of clinical features, disease activity, treatment and outcomes between late-onset and early-onset patients with systemic lupus erythematosus. A sex- and year at diagnosis-matched controlled study |
| title_short | Comparison of clinical features, disease activity, treatment and outcomes between late-onset and early-onset patients with systemic lupus erythematosus. A sex- and year at diagnosis-matched controlled study |
| title_sort | comparison of clinical features disease activity treatment and outcomes between late onset and early onset patients with systemic lupus erythematosus a sex and year at diagnosis matched controlled study |
| topic | Systemic lupus erythematosus Late-onset Outcomes Clinical manifestations Mortality |
| url | https://doi.org/10.1186/s42358-023-00297-0 |
| work_keys_str_mv | AT jarukitmongkolchaiarunya comparisonofclinicalfeaturesdiseaseactivitytreatmentandoutcomesbetweenlateonsetandearlyonsetpatientswithsystemiclupuserythematosusasexandyearatdiagnosismatchedcontrolledstudy AT antikawongthanee comparisonofclinicalfeaturesdiseaseactivitytreatmentandoutcomesbetweenlateonsetandearlyonsetpatientswithsystemiclupuserythematosusasexandyearatdiagnosismatchedcontrolledstudy AT nuntanakasitanon comparisonofclinicalfeaturesdiseaseactivitytreatmentandoutcomesbetweenlateonsetandearlyonsetpatientswithsystemiclupuserythematosusasexandyearatdiagnosismatchedcontrolledstudy AT worawitlouthrenoo comparisonofclinicalfeaturesdiseaseactivitytreatmentandoutcomesbetweenlateonsetandearlyonsetpatientswithsystemiclupuserythematosusasexandyearatdiagnosismatchedcontrolledstudy |