Late-onset Systemic Lupus Erythematosus
Mruthyunjaya P. Ahmed S. Botabekova A. Baimukhamedov C. Zimba O.
January 2025Springer Science and Business Media Deutschland GmbH
Rheumatology International
2025#45Issue 1
Systemic lupus erythematosus (SLE) is a multisystem autoimmune rheumatic disease (ARD) that results from the dysregulation of multiple innate and adaptive immune pathways. Late-onset SLE (Lo-SLE) is the term used when the disease is first diagnosed after 50–65 years, though the standard age cut-off remains undefined. Defining “late-onset” as lupus with onset after 50 years is more biologically plausible as this roughly corresponds to the age of menopause. Lo-SLE comprises nearly 20% of all cases of lupus. With advancing age, the female predominance of lupus declines to nearly 4:1 to even 1.1:1. The natural history of the disease varies, with lesser major organ involvement like nephritis but higher damage accrual. The latter is possibly owed to the atypical presentation and hesitation among physicians to diagnose SLE at this age, a diagnostic delay with late treatment initiation may accelerate the damage accrual. Multimorbidity is a central issue in these patients, which includes osteoporosis, sarcopenia, accelerated atherosclerosis in the background of existing dyslipidemia, diabetes mellitus, major depression, hypertension, coronary artery disease and other thrombotic events. With the rising ages of populations worldwide, awareness about late-onset lupus is paramount, especially due to the associated diagnostic delays and higher overlap with Sjogren’s disease. Also, pharmacotherapeutics must be optimized considering factors associated with ageing like declining glomerular filtration rate (GFR), sarcopenia, osteoporosis, and the associated comorbidities. Measures to minimize the exposure to long-term exposure to high-dose steroids are crucial. Beyond this, it is of essence to adopt non-pharmacological interventions as an adjunct to traditional immunosuppression to improve pain, fatigue, depression, and anxiety, improve cardiovascular health and overall better quality of life with favourable long-term outcomes.
Geriatrics , Immune senescence , Late onset disorders , Multimorbidity , Systemic lupus erythematosu
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Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, 751024, India
Department of General Practice N2, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
Shymkent Medical Centre of Joint Diseases, Shymkent, Kazakhstan
Department of Rheumatology, Immunology and Internal Medicine, University Hospital in Kraków, Kraków, Poland
National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
Department of Clinical Immunology and Rheumatology
Department of General Practice N2
Shymkent Medical Centre of Joint Diseases
Department of Rheumatology
National Institute of Geriatrics
Department of Internal Medicine N2
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