ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 733

Late Onset Systemic Lupus Erythematosus: A Different Disease Subset?

Anne Riveros Frutos1, Melania Martínez-Morillo1, Irma Casas2,3, Iñigo Rúa-Figueroa4, JM Pego-Reigosa5, M. Jesús García de Yebenes6, Alejandro Olivé1, José Rosas7, Paloma Vela Casasempere8, Monica Ibanez Barcelo9, Vicente Torrente10, Ivan Castellvi11, Javier Narváez12, Mireia Moreno13, Ricardo Blanco14, Víctor Martínez Taboada15, Jaime Calvo16, Ángeles Aguirre Zamorano17, Mercedes Freire18, Enrique Raya19, Celia Erausquin20, Esther Uriarte21, Elvira Diez Alvarez22, Tomás Vázquez Rodríguez23, Antonio Fernandez-Nebro24, Eva Tomero25, Paloma García de la Peña26, Ana Sánchez Atrio27, Monica Fernandez Castro28, Antonio Zea29, Patricia Richi30, Francisco Javier López Longo31, María Galindo32, Patricia E. Carreira33, Gema Bonilla34, Carlos Marras Fernandez-Cid35, Maria Loreto Horcada36, Carlos Alberto Montilla Morales37, Blanca Hernández-Cruz38, José Luis Marenco de la Fuente39, Marian Gantes40, Olaia Fernández Berrizbeitia41, Juan José Alegre42, Ángela Pecondón Español43, Manuel Rodríguez-Gómez44, Victor Quevedo45, José Hernández Beiraín46 and Lucía Silva Fernández47, 1Rheumatology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain, 2Preventive Medicine, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain, 3preventive medicine, Hospital Universitari Germans Trias i Pujol, barcelona, Spain, 4Rheumatology, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canarias, Spain, 5Rheumatology, Hospital Meixoeiro, Vigo, Spain, 6Research Unit of the SER, Madrid, Spain, 7Rheumatology, Hospital Marina Baixa, Villajoyosa, Spain, 8Rheumatology, Hospital General de Alicante, Alicante, Spain, 9H. Son Llatzer, Palma de Mallorca, Spain, 10Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain, 11Unitat de Reumatologia., Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, 12Rheumatology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain, 13Rheumatology, Hospital Parc Taulí, Sabadell, Spain, 14Reumatologia, Hospital Universitario Marques de Valdecilla, Santander, Spain, 15Rheumatology, Hospital Marqués de Valdecilla, Santander, Spain, 16Rheumatology, Hospital de Sierrallana, Torrelavega, Spain, 17Rheumatology, IMIBIC-Reina Sofia Hospital, Cordoba, Spain, 18Rheumatology, Hospital Universitario Juan Canalejo, La Coruña, Spain, 19Rheumatology, Hospital Clínico San Cecilio, Granada, Spain, 20Rheumatology, Hospital de Gran Canaria Dr Negrin, Las Palmas GC, Spain, 21Reumatología, Hospital de Donosti, Donosti, Spain, 22Rheumatology, Hospital de León, León, Spain, 23Rheumatology, Hospital Lucus Augusti, Lugo, Spain, 24Rheumatology, Hospital Universitario Carlos Haya, Malaga, Spain, 25Hospital La Princesa. Madrid., Madrid, Spain, 26Rheumatology, Hospital Universitario Madrid Norte Sanchinarro, Madrid, Spain, 27Hospital Principe de Asturias. Madrid, Madrid, Spain, 28Rheumatology, Hospital Puerta de Hierro, Madrid, Spain, 29Hospital Ramón y Cajal, Madrid, Spain, 30Hospital Infanta Sofía, Madrid, Spain, 31Hospital Gregorio Marañón, Madrid, Spain, 32Rheumatology, Hospital 12 de octubre, Madrid, Spain, 33Hospital 12 de Octubre, Madrid, Spain, 34Rheumatology, Hospital La Paz, Madrid, Spain, 35Hospital Virgen de la Arrixaca, Murcia, Spain, 36Rheumatology, Complejo Hospitalario de Navarra, Pamplona, Spain, 37Hospital Clínico Universitario de Salamanca, Salamanca, Spain, 38Rheumatology, Hospital Universitario Virgen Macarena, Sevilla, Spain, 39Rheumatology, Hospital de Valme, Seville, Spain, 40Hospital Universitario de Canarias, Tenerife, Spain, 41Rheumatology, Basurto University Hospital, Bilbao, Spain, 42Rheumatology Department, Hospital Universitario Doctor Peset, Valencia, Spain, 43Rheumatology, Hospital Miguel Servet, Zaragoza, Spain, 44Complejo Hospitalario Universitario de Ourense, Ourense, Spain, 45Rheumatology, Hospital de Monforte, Lugo, Spain, 46Rheumatology, Hospital Insular de Gran Canaria, Las palmas Gran Canarias, Spain, 47Hospital Universitario de Guadalajara, Guadalajara, Spain

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords:

Session Information

Date: Sunday, November 8, 2015

Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: To describe the demographic, clinical and immunological manifestations in patients with late onset systemic lupus erythematosus (SLE)

Methods: Patients diagnosed of SLE in the RELESSER data base (National Registry of Patients with Systemic Lupus Erythematosus of the Spanish Society of Rheumatology) were included. Late-onset was defined as >50 years of age at time of first SLE-related symptom. Design: multicenter retrospective cross-sectional study. Socio-demographic variables, comorbidities, classification, clinical and immunological manifestations were evaluated. Pearson´s chi-square test,  t-Student

Results: Of the 3628 patients included: 566 (15.6%) patients had late-onset SLE, 3062 (84.4%) patients were younger than 50 years. The mean age at diagnosis was 60.7(Sd 8.5) years in the late-onset SLE and 30.5 (Sd 9.96) years in the younger onset group. In the late onset group: 91 (16.1%) were male and 475 (83.9%) women. The male/female ratio was 5/1. Diagnosis in the younger onset group was sooner than in late-onset group (28.2 Sd 48.9 days compared with 45.3 Sd 70.3 days with P <0.0001).

Comparing comorbidities by age group, it was found that SLE patients over 50 years of age had more comorbidities with p<0.0001. Secondary Sjogren’s syndrome was more frequent in the older age group (p<0.001). Table 1: Clinical manifestations. During follow-up 205 patients died: 74 (14.3%) with late-onset SLE and 131 (4.7%) younger than 50 years (P <0.0001). Evaluating the cause of death, the group of younger patients had higher mortality due to SLE with statistical significance. The cause of death from severe infections and cancer was higher in patients over 50 years, but without statistical significance

Clinical manifestation

 

Older than 50 years. N (%)

Younger than 50 years. N (%)

Missing

N (%)

VALUE OF P

Systemic Manifestations

Lymphadenopathy

36(6,5%)

332(11%)

95 (2,6%)

0,002

Cutáneous Manifestations

Inflamatory rash

286(51,9%)

2076(87,9%)

84 (2,3%)

<0,0001

Alopecia

115(21%)

1161(38,7%)

108 (3,0%)

<0,0001

Osteoarticular Manifestations

Avascular bone necrosis

9(1,6%)

140(4,7%)

89 (2,4%)

0,001

Arthritis

74(13,2%)

285(9,4%)

81 (2,2%)

0,007

Osteoporosis

94(17,3%)

164(5,5%)

141 (3,9%)

<0,0001

Pulmonary Manifestations

Pleural fibrosis

19(3,4%)

52(1,7%)

64 (1,7%)

0,009

Pulmonary thromboembolism

24(4,3%)

79(2,6%)

55 (1,5%)

0,030

Cardiovascular Manifestations

Valvular disease

68(12,3%)

150(5%)

113 (3,1%)

<0,0001

Valvular dysfunction

31(5,9%)

90(3,1%)

245 (6,7%)

0,001

Angina

31(5,5%)

37(1,2%)

75 (2,1%)

<0,0001

Acute myocardial infarction

26(4,7%)

45(1,5%)

83 (2,3%)

<0,0001

Cardiomyopathy

41(7,4%)

63(2,1%)

100 (2,7%)

<0,0001

Peripheral vascular Manifestations

Raynaud

131(24,1%)

1055(35,7%)

160 (4,4%)

<0,0001

Renal Manifestations

Lupus nephritis

78(14,3%)

1003(33,4%)

110 (3,0%)

<0,0001

HTA in the first outbreak

39(7,1%)

360(12,4%)

201 (5,5%)

<0,0001

Hematuria

94(17,7%)

940(32,8%)

264 (7,2%)

<0,0001

Pyuria

47(9%)

687(24,6%)

337 (9,2%)

<0,0001

Creatinine clearance = 50 irreversible

41 (7,4%)

150 (5%)

131 (3,6%)

0,025

Proteinuria = 3,5g/24hs

6(1,1%)

127(4,3%)

145 (4,0%)

<0,0001

End stage renal disease

8(1,5%)

89(3%)

164 (4,5%)

0,039

Neuro psychiatric Manifestations

Lupus headache

13(2,4%)

199(6,6%)

110 (3,0%)

<0,0001

Depression

122(22,2%)

481(16%)

111 (3,0%)

<0,0001

Ocular Manifestations

Cataract

111(20,3%)

201(6,7%)

123 (3,4%)

<0,0001

Immunology

Complement

327(59,2%)

2433(81,2%)

108 (3,0%)

<0,0001

Ac anti RNP positive

84(15,2%)

792(26,9%)

162 (4,4%)

<0,0001

Conclusion: Patients with late-onset SLE have a higher risk of mortality than the younger-onset SLE. The diagnostic delay is higher in patients over 50 years. This group of patients have more comorbidities and higher risk of joint, pulmonary and cardiovascular involvement, on the contrary renal involvement is less common

Disclosure: A. Riveros Frutos, None; M. Martínez-Morillo, None; I. Casas, None; I. Rúa-Figueroa, None; J. Pego-Reigosa, Modest; Biocaps (grant 316265 ) of the 7th Framework Programme of the European Union ( FP7 / REGPOT - 2012-2013.1 ) ., FIS ( ISCIII ) PI11 / 02857. C. Other Research Support (supplies, equipment, receipt of drugs or other in-kind support); Modest; GSK , U, 2; M. J. García de Yebenes, None; A. Olivé, None; J. Rosas, None; P. Vela Casasempere, None; M. Ibanez Barcelo, None; V. Torrente, None; I. Castellvi, None; J. Narváez, None; M. Moreno, None; R. Blanco, None; V. Martínez Taboada, None; J. Calvo, None; Aguirre Zamorano, None; M. Freire, None; E. Raya, None; C. Erausquin, None; E. Uriarte, None; E. Diez Alvarez, None; T. Vázquez Rodríguez, None; A. Fernandez-Nebro, None; E. Tomero, None; P. García de la Peña, None; A. Sánchez Atrio, None; M. Fernandez Castro, None; A. Zea, None; P. Richi, None; F. J. López Longo, None; M. Galindo, None; P. E. Carreira, None; G. Bonilla, None; C. Marras Fernandez-Cid, AbbVie, 5; M. L. Horcada, None; C. A. Montilla Morales, None; B. Hernández-Cruz, None; J. L. Marenco de la Fuente, None; M. Gantes, None; O. Fernández Berrizbeitia, None; J. J. Alegre, None; Pecondón Español, None; M. Rodríguez-Gómez, None; V. Quevedo, None; J. Hernández Beiraín, None; L. Silva Fernández, None.

To cite this abstract in AMA style:

Riveros Frutos A, Martínez-Morillo M, Casas I, Rúa-Figueroa I, Pego-Reigosa J, García de Yebenes MJ, Olivé A, Rosas J, Vela Casasempere P, Ibanez Barcelo M, Torrente V, Castellvi I, Narváez J, Moreno M, Blanco R, Martínez Taboada V, Calvo J, Aguirre Zamorano , Freire M, Raya E, Erausquin C, Uriarte E, Diez Alvarez E, Vázquez Rodríguez T, Fernandez-Nebro A, Tomero E, García de la Peña P, Sánchez Atrio A, Fernandez Castro M, Zea A, Richi P, López Longo FJ, Galindo M, Carreira PE, Bonilla G, Marras Fernandez-Cid C, Horcada ML, Montilla Morales CA, Hernández-Cruz B, Marenco de la Fuente JL, Gantes M, Fernández Berrizbeitia O, Alegre JJ, Pecondón Español , Rodríguez-Gómez M, Quevedo V, Hernández Beiraín J, Silva Fernández L. Late Onset Systemic Lupus Erythematosus: A Different Disease Subset? [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/late-onset-systemic-lupus-erythematosus-a-different-disease-subset/. Accessed .

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