Comparison of clinicopathological characteristics and outcomes between patients with late and early-onset systemic lupus erythematosus with lupus nephritis: A North African study

ObjectivesThe aim of this study was to compare the clinicopathological characteristics and outcomes of lupus nephritis (LN) between late-onset and early-onset systemic lupus erythematosus (SLE) patients.MethodsWe reviewed the clinical, serological and histological characteristics of all patients with LN admitted to our nephrology unit between 2007 and 2024. Our patients were divided into two groups according to their age at diagnosis: Early-onset SLE (younger than 50 years) and late-onset SLE (50 years or older).ResultsA total of 231 patients were recruited, of whom 43 had late-onset SLE and 188 had early-onset SLE. The mean age at diagnosis of SLE was 58.36 ± 7.61 years in the late-onset SLE group and 29.23 ± 9.03 years in the early-onset SLE group. There was no difference in the time from SLE diagnosis to LN. Compared with early-onset group, late-onset group had a higher prevalence of discoid rash but a lower frequency of leukopenia. Late-onset patients had higher serum creatinine levels and lower prevalence of anti-SSA and anti-RNP antibodies. The frequency of class VI LN was statistically significantly higher in the late-onset group. The use of oral corticosteroids, hydroxychloroquine and immunosuppressive drugs was significantly lower in late-onset SLE patients than in early-onset SLE patients. The latter were significantly less likely to progress to chronic kidney disease.ConclusionOur results indicate that SLE patients have different clinical, serological and histological manifestations depending on the age at onset of the disease. Late-onset SLE patients are more likely to have rheumatoid arthritis at onset. They have more severe chronic renal lesions and a worse renal outcome.