Differences in disease phenotype and severity in SLE across age groups

Ambrose, N, Morgan, TA, Galloway, J, Ionnoau, Y, Beresford, MW ORCID: 0000-0002-5400-9911 and Isenberg, DA (2016) Differences in disease phenotype and severity in SLE across age groups. LUPUS, 25 (14). pp. 1542-1550.

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Abstract

<h4>Objectives</h4>Significant differences have been reported in disease phenotype and severity of systemic lupus erythematosus (SLE) presenting in different age groups. Most indicate a more severe phenotype in juvenile-onset SLE (JSLE). There have been limited studies in older patients and no large studies looking at SLE across all age groups.<h4>Methods</h4>We assessed the effect of age of onset of SLE on the clinical phenotype by analysing data from two large UK cohorts (the UK JSLE Cohort and the UCLH SLE cohort).<h4>Results</h4>A total of 924 individuals were compared (413 JSLE, 511 adult-onset SLE). A female preponderance was present, but less pronounced at either end of the age spectrum. Arthritis was more common with advancing age (93% vs 72%, p < 0.001), whereas renal disease (44% vs 33%, p = 0.001), alopecia (47% vs 23%, p < 0.001) and aphthous ulcerations (39% vs 26%, p = 0.001) were more common in the young. Neuropsychiatric lupus was less common in mature-onset SLE (p < 0.01). JSLE was associated more commonly with thrombocytopenia (21% vs 15%, p = 0.01), haemolytic anaemia (20% vs 3%, p < 0.001), high anti-dsDNA (71% vs 63%, p = 0.009), Sm (22% vs 16%, p = 0.02) and RNP (36% vs 29%, p < 0.04) auto-antibodies. Leucopenia increased with advancing age (p < 0.001). Mortality has been declining over recent decades. However, death rates were substantially higher than the general population. The standardized mortality ratio was 18.3 in JSLE and 3.1 in adult-onset SLE.<h4>Conclusion</h4>These data from the largest-ever direct comparison of JSLE with adult-onset SLE suggest an aggressive phenotype of disease with a worse outcome in patients with JSLE and emphasizes the importance of careful follow-up in this population.

Item Type:	Article
Uncontrolled Keywords:	Cohort study, juvenile-onset SLE, childhood-onset SLE
Depositing User:	Symplectic Admin
Date Deposited:	07 Apr 2017 09:56
Last Modified:	19 Jan 2023 07:19
DOI:	10.1177/0961203316644333
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3005495