Characteristics of Late-Onset Systemic Lupus Erythematosus: Clinical Manifestations and Diagnostic and Treatment Challenges

Abstract

Systemic lupus erythematosus (SLE) is widely recognized as a systemic autoimmune disease predominantly affecting young women. However, since the initial report in 1959, cases of late-onset SLE have been increasingly documented. Late-onset SLE, commonly defined as disease onset at or after 50 years of age, sometimes exhibits different clinical characteristics compared with the typical SLE phenotype. There is a higher proportion of male patients and a lower frequency of skin rash, renal involvement, neuropsychiatric manifestations, hypocomplementemia, and anti-DNA antibody seropositivity, whereas serositis is observed more frequently. Furthermore, although disease activity in late-onset SLE is generally lower, it is associated with more severe irreversible organ damage and a poorer prognosis. Data shows that the use of immunosuppressive drugs in late-onset SLE is lower, which may be due to delay in diagnosis, different manifestations, and the presence of comorbidities. However, the clinical situation would have merited their use. Given the aging of the global population, the prevalence of late-onset SLE is expected to increase. A thorough understanding of the characteristics of late-onset SLE may facilitate early diagnosis and appropriate treatment, ultimately improving patient outcomes. This review summarizes the reported characteristics of late-onset SLE and discusses the key considerations for its accurate diagnosis and effective management.