Systemic lupus erythematosus in geriatrics

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease characterized by heterogeneous multisystem involvement and the production of autoantibodies to nuclear and cytoplasmic antigens. Although SLE is most prevalent among women of childbearing age, it may present at any age and in either gender. Clinical manifestations are similar at all ages but incidence and severity differ. Late onset SLE is defined as age of onset of 50 years and above and presents with a frequency of 2.9-18% of adult onset SLE patients. Diagnosis of SLE in older adult patients is often delayed due to its insidious onset, lower number of cumulative SLE criteria, nonspecific presentation and lack of awareness. Pulmonary manifestations such as serositis, pleuritis and interstitial lung disease and Sicca symptoms are more common. Renal, dermatologic and Lupus related neuropsychiatric manifestations are less common in late onset SLE. Comorbidities are higher in patients with late onset SLE and include hypertension, arterial thrombotic events, osteoporosis and hypertriglyceridemia. SLE treatment does not differ in most studies except for lower use of cyclophosphamide. Even though SLE tends to be less active in older patients, age is a factor for poor outcome due to higher damage accrual, therefore survival of patients with late onset SLE is reduced. Most elderly patients with SLE are probably those diagnosed before the age of 65 and even patients diagnosed in childhood, therefore they are subject to long term toxicities of medications. Elderly SLE patients need to be closely followed in order to reduce the occurrence of damage and morbidity from infections, cardiovascular disease and osteoporosis.