Elderly-onset systemic lupus erythematosus
Elderly-onset systemic lupus erythematosus
复制标题
DOI：
10.2165/00002512-200724090-00001
复制
发表时间：
2007-01-01
期刊：
影响因子：
2.8
通讯作者：
Lazaro, Deana
中科院分区：
文献类型：
--
作者：
Lazaro, Deana
系统性红斑狼疮是一种病因不明的自身免疫性多系统疾病，临床表现多变。育龄妇女最常受影响;然而，大约10-20%的病例发生在老年患者中。在各种研究中，老年性狼疮被定义为50-65岁之后的狼疮发作。绝经和细胞免疫功能随年龄增长的变化可能是老年狼疮的发病原因。许多研究表明，老年狼疮的临床和血清学特征与年轻狼疮患者不同。关节炎、发热、浆膜炎、干燥症状、雷诺综合征、肺部疾病和神经精神症状在老年狼疮患者中更常见，而与年轻狼疮患者相比，颧骨皮疹、盘状狼疮和肾小球肾炎在老年狼疮患者中较少见。大多数老年狼疮患者抗核抗体检测阳性，但抗双链DNA和低补体血症的患病率在老年患者中低于年轻患者。老年人发病时，抗Ro/Sjogren综合征（SS）A、抗La/ SSB抗体阳性率较高。老年性狼疮的诊断可能会延迟数月：起病隐匿，患病率低，与其他更常见的疾病相似，这使得老年性狼疮的诊断具有挑战性。老年性狼疮的治疗可能会因合并症而复杂化，并且常规治疗的毒性风险增加。由于缺乏随机对照研究，老年性狼疮的最佳治疗是经验性的。然而，治疗方法是相似的，无论患者的年龄。本文讨论的患病率，临床过程中，血清学特征，预后和治疗老年发病的系统性红斑狼疮。
Systemic lupus erythematosus is an autoimmune multi-system disease of uncertain aetiology with highly variable clinical manifestations. Women of childbearing age are most often affected; however, approximate to 10-20% of cases occur in older patients. Elderly-onset lupus has been defined in various studies as onset of lupus after age 50-65 years. Menopause and changes in cellular immunity with aging may contribute to development of lupus in older adults.Many studies suggest that the clinical and serological features of elderly-onset lupus differ from those of lupus in younger patients. Arthritis, fever, serositis,sicca symptoms, Raynaud's syndrome, lung disease and neuropsychiatric symptoms are more common in patients with elderly-onset lupus, while malar rash, discoid lupus and glomerulonephritis are less common in elderly-onset patients compared with younger lupus patients. Most elderly-onset lupus patients have a positive anti-nuclear antibody test, but the prevalence of anti-double-stranded DNA and hypocomplementaemia is lower in eldrly-onset patients than in younger patients. Rheumatoid factor, anti -Ro/Sjogren's syndrome (SS) A and anti-La/ SSB are more often positive in elderly-onset patients. The diagnosis of elderly-onset lupus may be delayed for many months: insidious onset, low prevalence and similarity to other more common disorders make the diagnosis of lupus challenging in this population.Treatment of lupus in the elderly may be complicated by co-morbidities and increased risk of toxicities from usual treatments. Optimal management of elderly-onset lupus is empiric because of a lack of randomised controlled studies. However, the approach to treatment is similar regardless of the age of the patient.This article discusses the prevalence, clinical course, serological features, prognosis and treatment of elderly-onset systemic lupus erythematosus.