LATE-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS : ABOUT 5 CASES.

PV203 / #609 Poster Topic: AS23 - SLE-Diagnosis, Manifestations, & Outcomes Background/Purpose Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that usually affects young women in their third decade, but can occur at any age. SLE is said to have a late onset when the diagnosis is made at the age of 50 or over. Studies of this entity are few. The aim of our study was to investigate the clinico-biological, immunological, therapeutic and evolutionary features of late-onset SLE. Methods This is a monocentric, descriptive, retrospective study conducted in the internal medicine department of the university hospital center Ibn Rochd Casablanca including records of patients hospitalized for SLE (fulfilling SLICC 2012 and EULAR/ACR 2019 criteria) during the period between 2015 and 2024 and who were 50 years of age or older at the time of diagnosis. Results Our series included 5 lupus patients. They were 4 women and 1 man with a mean age at diagnosis of 58.6 years. The mean SLEDAI score was 17.8. The mean time to diagnosis was 10.4 months. Comorbidities were dominated by dyslipidemia (40%) and arterial hypertension (20%). Revealing manifestations of SLE were usually pure nephrotic syndrome, pericardial effusion and deep-vein thrombosis. Inflammatory polyarthralgia was the inaugural manifestation in 2 patients (40%), and Raynaud’s phenomenon in 2 patients (40%). In our series, the most frequent pathologies were renal, hematological and serositis. As regards the biological workup, all patients presented lymphopenia and proteinuria > 0.5 g/24h, a biological inflammatory syndrome and autoimmune hemolytic anemia (AIHA) were noted in 80% of cases, leukopenia in 60% and thrombocytopenia was observed in 40%. On the immunological front, antinuclear antibodies were positive in all patients. Anti-SSA and anti-SSB were positive in 40% and 20% of cases respectively. Anti-phospholipid and anti-nucleosome antibodies were positive in 40% of cases. Anti-DNAnative, anti-ribosome, anti-Sm and anti-histone antibodies were positive in 20% of cases, and complement consumption C3 and C4 was observed in a single patient. The association with another autoimmune disease (AID) was observed in 3 patients. One patient had an authentic Sjögren’s syndrome, another an antiphospholipid syndrome (APS) and the 3rd a combination of the 2. All our patients were treated with synthetic antimalarials and corticosteroids. Four of our patients were treated with immunosuppressants: cyclophosphamide was prescribed for 2 patients and azathioprine (AZA) for 2 patients. All showed a favorable course of treatment. Conclusions Late-onset SLE is most often characterized by an insidious onset and unspecific inaugural signs. It is a diagnosis that should not be dismissed, even after the age of 50. In our context, severe symptoms are often observed, contrary to what is described in the literature. This is because our climate is very sunny, which partly explains the severity of the disease. The presence of other autoimmune diseases is frequent. Treatment differs little from that of younger patients, and must also take into account the patient’s comorbidities. Early diagnosis and treatment guarantee a good outcome.

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