CLINICAL ONSET OF LUPUS ERYTHEMATOSUS IN THE OLDER AGE GROUP

The original concept of systemic lupus erythematosus was that of a rapidly progressive, often fulminant, fatal disease primarily affecting women in the reproductive age group. Subsequent observations, however, have revealed many additional and protean aspects of this disorder. The purpose of this report is to call attention to the onset of the disease in one specific group in which it is not often suspected, namely, patients in the sixth decade of life or later (1-8). Although the age range for appearance of the disease is from 2 to 73 years, most of the cases (75-84 per cent) occur between the ages of 10 and 40 years, the average age at onset being from 25 to 30 years. Despite the inclusion of patients aged 50 or over in statistical summaries of previously published series, there has been only 1 such patient reported in detail. Knopf and Castor (9) presented the case of a woman in whom, at age 66, joint pains, pleural effusion and thrombocytopenia developed in association with diagnostic findings in a lupus erythematosus cell preparation. At the time of publication, the patient’s symptoms were controlled with minimal dosages of prednisone, aspirin and antimalarials. In the period 1950-1958,5 patients with systemic lupus erythematosus whose disease became manifest in the sixth decade of life or later, were studied in the Hematology Section of the Department of Medicine at Temple University Medical Center. This incidence suggests a frequency of onset of systemic lupus erythematosus in the older population greater than generally recognized. Analysis of these cases permits certain preliminary observations on the nature of this variable disease in the elderly patient.