Background/Purpose:  Systemic lupus erythematosus (SLE) is an autoimmune disease which disproportionately affects women of child-bearing age.  However, onset during childhood and late adult onset can be seen.  Previous studies found that age of onset may be predictive of certain clinical manifestations and childhood-onset associated with increased mortality. The purpose of our study is to compare the clinical differences between childhood, adult, and late onset SLE within a large predominantly African American cohort.

Methods: Participants enrolled in an observational database of SLE were included in this study if they met ≥4 of 11 modified ACR Classification Criteria for SLE.  Data was collected prospectively from 2003 to 2012. Demographic and clinical features were collected at baseline and updated at follow-up visits.  Damage was scored using the SLICC/ACR Damage Index (SDI). Age of onset was categorized in three groups: childhood onset (<18 years old), adult onset (18 – 50 years old), and late onset (>50 years old).

Chi-squared or Fisher’s Exact testing was used, as appropriate, to compare characteristics between groups. All statistical testing used a two-sided α=0.05 level.

Results: Of the 449 patients, 91.3% were female and 80.6% were African American.  Age of SLE onset varied between 2.8 and 76.6 years of age (mean 30.8 ± 13.6) and year of diagnosis varied between 1973 and 2012. Data on the demographic, clinical, and laboratory characteristics between the childhood onset (n=83), adult onset (n=317), late onset (n=41) groups is presented in Table 1.

Table 1. Patient characteristics compared between groups diagnosed with SLE in childhood (<18 years), adulthood (18-50 years), or late-adulthood (>50 years).

Late onset patients have a higher proportion of females to males compared to childhood onset, but are significantly less likely to be African American. Childhood onset patients have the highest prevalence of renal and neurologic involvement from SLE (p-values <0.01 and 0.01 respectively) and were more likely, although not statistically significant, to have irreversible damage as reflected by the SDI.

Conclusion:  These results support childhood onset SLE being a more severe form of SLE, supporting the critical need for preventive interventions early in the course of disease. Patients with earlier onset of SLE were more likely to have renal and neurologic involvement, which are leading causes of morbidity and mortality in SLE.