A systematic review and meta-analysis of cutaneous manifestations in late- versus
early-onset systemic lupus erythematosus
#MMPMID26972993
Medlin JL
; Hansen KE
; Fitz SR
; Bartels CM
Semin Arthritis Rheum
2016[Jun]; 45
(6
): 691-7
PMID26972993
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OBJECTIVES: Although systemic lupus erythematosus (SLE) most commonly occurs in
reproductive-age women, some are diagnosed after the age of 50. Recognizing that
greater than one-third of SLE criteria are cutaneous, we undertook a systematic
review and meta-analysis to evaluate differences in cutaneous manifestations in
early- and late-onset SLE patients. METHODS: We searched the literature using
PubMed, CINAHL, Web of Science, and Cochrane Library. We excluded studies that
did not include ACR SLE classification criteria, early-onset controls, that
defined late-onset SLE as <50 years of age, or were not written in English. Two
authors rated study quality using the Newcastle Ottawa Quality Scale. We used
Forest plots to compare odds ratios (95% CI) of cutaneous manifestations by age.
Study heterogeneity was assessed using I(2). RESULTS: Overall, 35 studies,
representing 11,189 early-onset and 1727 late-onset patients with SLE, met
eligibility criteria. The female:male ratio was lower in the late-onset group
(5:1 versus 8:1). Most cutaneous manifestations were less prevalent in the
late-onset group. In particular, malar rash [OR = 0.43 (0.35, 0.52)],
photosensitivity [OR = 0.72 (0.59, 0.88)], and livedo reticularis [OR = 0.33
(0.17, 0.64)] were less common in late-onset patients. In contrast, sicca
symptoms were more common [OR = 2.45 (1.91, 3.14)]. The mean Newcastle Ottawa
Quality Scale score was 6.3 ± 0.5 (scale: 0-9) with high inter-rater reliability
for the score (0.96). CONCLUSIONS: Overall, cutaneous manifestations are less
common in late-onset SLE patients, except sicca symptoms. Future studies should
investigate etiologies for this phenomenon including roles of immune senescence,
environment, gender, and immunogenetics.
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