Late-onset systemic lupus erythematosus: characteristics and outcome in comparison to juvenile- and adult-onset patients—a multicenter retrospective cohort

  • Basma M MedhatEmail author
  • Mervat Essam Behiry
  • Nesreen Sobhy
  • Yomna Farag
  • Huda Marzouk
  • Noha Mostafa
  • Iman Khalifa
  • Marwa Elkhalifa
  • Basma M. Eissa
  • Eman Hassan ElSayed Hassan
Original Article



The aim of this study was to investigate the characteristics and outcome of systemic lupus erythematosus (SLE) among elderly-onset patients.


This study included 575 SLE patients managed at Cairo, Alexandria, and Helwan universities from August 2014 to 2018: of whom 49 (8.5%), 420 (73%), and 106 (18.4%) were elderly- (> 50 years), adult- (17–50 years), and juvenile- (≤ 16 years) onset patients, respectively. Cumulative characteristics were recorded. Disease activity at the last visit was investigated through the Systemic Lupus Erythematosus Disease Activity Index-2K (SLEDAI-2K), whereby lupus low disease activity (LLDA) was defined as a SLEDAI-2K score ≤ 4. The disease outcome was assessed through investigating disease damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)) and the prevalence of mortality. Quantitative and categorical data were compared using Kruskal–Wallis and Mann–Whitney tests, and chi-square (χ2) test, respectively.


Late-onset SLE (LSLE) patients demonstrated the lowest prevalence of constitutional and mucocutaneous manifestations (p < 0.001), serositis (p = 0.006), nephritis (p < 0.001), neuropsychiatric involvement (p < 0.001), and hypocomplementinemia (p < 0.001), but showed the highest prevalence of comorbidities and multimorbidity (comorbidities ≥ 2) (p < 0.001), and positive anti-ds DNA antibodies (p < 0.001). Elderly-onset patients demonstrated the lowest SLEDAI-2K and SDI scores, achieved LLDA the most (p < 0.001), and developed any damage (SDI ≥ 1) the least (p < 0.001). The prevalence of mortality was comparable across the three age groups (p = 0.6).


Late-onset SLE patients (8.5%) showed the lowest prevalence of major organ involvement and the highest prevalence of comorbidities, and demonstrated more favorable disease activity and damage indices.

Key Points

• The disease characteristics and outcome among LSLE patients are characterized by being controversial, with studies from the Middle East being limited. Our cohort constituted of 8.5% elderly-onset SLE patients—who were characterized by the lowest prevalence of major organ involvement and the lowest activity and damage indices—making the disease pattern more favorable in this age group, despite being characterized by the highest prevalence of comorbidities.


Characteristics Disease outcome Elderly onset Juvenile Late onset Systemic lupus erythematosus 


Compliance with ethical standards

The study was approved by the local Ethics Committee, according to the provisions of the World Medical Association Declaration of Helsinki.




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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  • Basma M Medhat
    • 1
    Email author
  • Mervat Essam Behiry
    • 2
  • Nesreen Sobhy
    • 1
  • Yomna Farag
    • 3
  • Huda Marzouk
    • 3
  • Noha Mostafa
    • 3
  • Iman Khalifa
    • 4
  • Marwa Elkhalifa
    • 5
  • Basma M. Eissa
    • 1
  • Eman Hassan ElSayed Hassan
    • 5
  1. 1.Rheumatology and Rehabilitation Department, Faculty of MedicineCairo UniversityCairoEgypt
  2. 2.Internal Medicine Department, Faculty of MedicineCairo UniversityCairoEgypt
  3. 3.Pediatric Rheumatology Department, Faculty of MedicineCairo UniversityCairoEgypt
  4. 4.Pediatric Department, Faculty of MedicineHelwan UniversityHelwanEgypt
  5. 5.Rheumatology Unit, Internal Medicine Department, Faculty of MedicineAlexandria UniversityAlexandriaEgypt

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