Clinical Features Of Late Onset Systemic Lupus Erythematosus -Analysis Of A Single Center Experience

Aim:The aim of this study was to evaluate the clinical, laboratory, renal pathological features of late onset systemic lupus erythematosus(SLE) and it’s treatment response to immunosuppressions.Methods:The clinical presentation, laboratory data, pathological lesions and treatment response of the late onset SLE (230 age≥50,67 with renal biopsy),were reviewed and compared with those of the early onset SLE in the same period (349 age≤50,134 with renal biopsy).Results:Compared with early onset group, lower female predominance was observed in the late onset patients (p<0.001). In comparison with early onset group, malar rash, photosensitivity, alopecia and renal damage occurred less frequently (p<0.05),but higher frequency of leukocytopenia was observed (p=0.042) in the late onset group. Furthermore, hypocomplementemia, specific. antibody were seen less frequently in the late onset group. Regarding the pathological classification of lupus nephritis, there was significant difference between the two groups (p=0.021), Classes Ⅲ was more common in late onset, whereas class IV was seen more frequently in the early onset group. Compared with early onset group, there were significant lower scores of endocapillary hypercellularity (p=0.006), glomerular leukocyte infiltration (p=0.015), karyorrhexis/fibrinoid necrosis (p=0.038) and interstitial inflammation (p=0.048) in the late onset group,and there were seen higher scores of glomerular sclerosis (p<0.001),tubular atrophy (p< 0.001), interstitial fibrosis (p=0.001) and chronic index (p< 0.001) in the late onset group. There was no significant difference in activity index between the two groups (p=0.312). The complete remission rate was 36% and effective rate was 84% in part of late onset SLE,who had undergone renal-biopsy and were followed up more than six month.Conclusions:Dute to the atypical clinical manifestation and the lower frequency of specific antibody,patients with late onset SLE are misdiagnosed easily. The pathological alterations of lupus nephritis was relatively mild and class Ⅲ was the most common type,yet,more chronic lesions occur in the ate onset SLE. And it’s necessary to combine steroid and immunosuppressants when kidney significantly effected.