Pulmonary Manifestations More Likely in Patients with Late-Onset SLE, Study Suggests

Pulmonary manifestations, specifically interstitial lung disease (ILD) and serositis — inflammation of tissues lining the lungs — are more common in late-onset systemic lupus erythematosus (SLE) patients than in those with early-onset disease, a study shows.

The study, “Pulmonary manifestations in late versus early systemic lupus erythematosus: A systematic review and meta- analysis Pulmonary Manifestations in Late Versus Early Lupus,” was published in the journal Seminars in Arthritis and Rheumatism.

SLE is an autoimmune disease that often begins early in life and can present symptoms ranging from rashes and joint pain to life-threatening lung and kidney involvement.

Late-onset SLE is a distinct classification that begins in patients older than 50. Prior studies have reported significant differences in the clinical manifestations of late-onset SLE patients.

In particular, a recent meta-analysis reported there were increased pulmonary manifestations in adult-onset lupus patients than childhood-onset patients, suggesting a higher risk with increasing age. However, patients with late-onset lupus were not included in this study.

While other studies have suggested increased pulmonary involvement in late-onset patients, researchers have not been able to make any conclusions because of the limited sample size of these studies.

Therefore, researchers at the University of Wisconsin set out to conduct a systematic review and meta-analysis to evaluate the differences in pulmonary manifestations between late-onset and early-onset SLE.

After conducting an extensive literature search, researchers found 39 studies, which included 10,963 early-onset and 1,656 late-onset SLE patients, that met the eligibility criteria for the meta-analysis.

Overall results showed the odds of developing several pulmonary diseases were significantly higher in the late-onset group.

In particular, patients with late-onset SLE were 2.56 times more likely to develop interstitial lung disease, 1.53 times more likely to develop pleuritis (inflammation of a membrane of the lung), and 1.31 times more likely to develop serositis than patients in the early-onset group.

“Pulmonary manifestations of SLE were more common in late-onset SLE patients compared to their younger peers, in particular ILD and serositis,” the investigators concluded.

Researchers suggest this phenomenon might be due to age-related changes in the immune system, tobacco exposure, race, or possible overlap with Sjögren’s syndrome.

Clinicians should be aware and recognize that late-onset patients are more likely to have interstitial lung disease, and should screen for the condition when appropriate.