Clinical Manifestations And Immunological Features Of Systemic Lupus Erythematosus With Different Age-onset Groups In China

Background Systemic lupus erythematosus(SLE)is a systemic autoimmune disease involving multiple organs with multiple clinical manifestations and is common in female patients.The incidence rate for men and women is 1:9.Different clinical manifestations and positive autoantibodies can occur in SLE patients of different ages,genders,and ethnicities.Previous reports have found that adolescent SLE patients are more prone to butterfly erythema,photosensitivity,kidney involvement,nervous system involvement,fever and hemolytic anemia,while late-onset SLE patients are often prone to serositis and arthritis.However,there are few studies on the differences in clinical manifestations and autoantibodies between three groups of SLE patients with different ages of onset.Objectives Our study is to reveal the differences in clinical manifestations and immunological features between systemic lupus erythematosus(SLE)patients with different onset age group,and the association between immunological features and clinical manifestations in Chinese SLE patients.Methods Among the patients studied,we collected 1913 Chinese SLE patients,including 342 patients in the juvenile-onset group(?18 years old),1360 patients in the early-onset group(between 18 and 45 years old)and 211 patients in the late-onset group(>45 years old).The clinical manifestations and laboratory test results of each patient in the statistical epidemiological questionnaire were analyzed by SPSS,and P-valuesbelow 0.05 were considered to be statistically significant.The clinical manifestations and autoantibody data were analyzed by Chi-square test and Fisher's exact probability method.The P value <0.05 was considered to be statistically significant.Results After analysis by SPSS software,the frequency of five clinical features are significantly higher in juvenile group and the early-onset group,such as malar rash(P <0.001),photosensitivity(P < 0.001),renal damage(P = 0.027),alopecia(P = 0.006),and low complement C3(P = 0.014).The possibility of the above five clinical features is accompanied by a decreasing trend with an increase in the age of onset.Conversely,several clinical phenotypes were more likely to occur in the late-onset group,such as serositis(P = 0.012),arthritis(P < 0.001)and high level of anti-Ro antibody(anti-SSA antibodies,P < 0.001).Anti-Sm antibody was associated with oral ulcers in SLE patients(P=0.03,OR=0.798,95% CI 0.651-0.979).Anti-dsDNA antibody(P < 0.001,OR = 1.601,95% CI 1.333-1.923)and low complement C3(P < 0.001,OR = 1.624,95% CI 1.348-1.957)were associated with renal damage in SLE patients.Conclusions The study suggested that the clinic manifestations and immunological features were different between juvenile group,early-onset group and late-onset group.juvenile group were susceptible to malar rash,photosensitivity,renal damage and low complement C3.Patients with early-onset are prone to have alopecia;patients in the late-onset group are prone to have serositis,arthritis and anti-SSA antibody positive.In SLE patients,anti-Sm antibody positive was negatively correlated with oral ulcer,while low complement C3 and anti-dsDNA antibody positive were positively correlated with renal damage.Notably,early detecting of renal damage in the juvenile group and treating of serositis and arthritis in the late-onset group may contribute to improve the quality of life and reduce mortality of patients with SLE.