Retrospective Study On Clinical Features And Treatment Of Late Onset Systemic Lupus Erythematosus

Objective: SLE is an autoimmune disease involving multiple organs and systems in women of childbearing age.The onset after menopause or after the age of 50 is called late-onset systemic lupus erythematosus,with the improvement of diagnosis level and clinical understanding,LSLE gradually increases clinically,because such patients have been outside the reproductive age and may be combined with underlying diseases,therefore,its clinical characteristics and prognosis may be significantly different from young and middle-aged systemic lupus erythematosus,understanding these differences will undoubtedly help to develop more reasonable treatment for LSLE patients,reduce the medical damage caused by insufficient or excessive treatment to patients.Methods: A systematic review study was conducted on the medical records of 170 patients with confirmed systemic lupus erythematosus who were treated at the First Affiliated Hospital of Wannan Medical College(Yijishan Hospital)from September 2017 to early June 2022.Of these,51(30%)were LSLE and 119(70%)were ASLE.The general data of the two groups of patients,such as gender,age,onset and time of presentation,were collected;Combined underlying diseases,various body fluid test indicators,clinical manifestations,treatment and use of drugs;SLEDAI-2000 and BILAG-200 were used to evaluate the degree of activity and organ damage in all patients.The two groups were compared and analyzed by statistical methods such as 2 test,Mann-Whitney U test,and independent sample t-test.Result: The mean age at diagnosis in the LSLE group was(59±7)years,female: male = 9.2:1,compared with the ASLE group,the LSLE group had a longer time from onset to diagnosis(March vs January,P=0.001),LSLE had more patients with one or more underlying diseases(P<0.001)when SLE was diagnosed,and the most common comorbidity was hypertension.In the clinical manifestations,fever(P = 0.037),rash(P<0.001)and photoallergy symptoms(P<0.001)were less common in the LSLE group.LSLE combined with Sjogren’s syndrome is more common(P<0.001).In laboratory tests,LSLE group was more likely than ASLE group to have leukopenia(P=0.01),increased ferritin(P=0.031),less hypocomplement(P=0.002),increased glutamyltransferase(P=0.011),and increased cystatinC(P=0.006).In terms of autoantibodies,the positive rate of anti-ds-DNA antibody decreased(P=0.018),the positive rate of anti-sm antibody decreased(P=0.03),and the positive rate of anti-β2-glycoprotein 1 antibody increased significantly(P=0.014).The SLEDAI-2000(P=0.024)and BILAG-2004(P<0.001)scores in the LSLE group were significantly lower than those in the ASLE group.After the LSLE group completed the disease activity assessment,the maximum mean dose of glucocorticoids(P=0.001)and the mean proportion of glucocorticoids used(mg·kg-1·d-1)(P=0.02)were lower,the use rate of immunosuppressants was lower(P=0.004),and fewer types of immunosuppressants were used(P=0.001).The use rates of mycophenolate mofetil(P=0.017),cyclophosphamide(P=0.002),and methotrexate(P=0.022)were significantly lower than those in the ASLE group.Conclusion: Compared with ASLE,the typical clinical manifestations of LSLE,such as rash,light sensitivity are not significant,the onset to diagnosis is longer,Sjogren’s syndrome is easy to be complicated,the degree of SLE disease activity and visceral damage is relatively low,retrospectively found that the glucocorticoid dose used is lower and the types of immunosuppressants are few.