Difference and connection of clinical features and ANA patterns in new-onset SLE cross age groups

Abstract

Abstract Background Systemic lupus erythematosus (SLE) is a common autoimmune disease, the clinical features of which will change a lot by onset age. To investigate the differences in autoantibodies, clinical features, and the relationship between antinuclear antibody (ANA) patterns, autoantibodies, and symptoms among different age groups. Methods We conducted a retrospective cohort study involving 556 patients diagnosed with SLE. These patients were classified into three groups: Group 1 comprised individuals with juvenile-onset SLE (< 18 years); Group 2 included those with early-onset adult SLE (18–50 years); and Group 3 consisted of patients with late-onset SLE (≥ 50 years). We utilized a clustering heatmap to identify variations and associations of autoantibodies among the three groups. The Kruskal-Wallis test was performed to compare autoantibodies, clinical manifestations, and laboratory measurements across the groups. The Chi-square test and correlation heatmap were used to analyze the relationship of ANA patterns with autoantibodies and symptoms. Results Our findings revealed that patients with late-onset SLE had a significantly lower prevalence of anti-dsDNA (56.0% vs. 70.5%, P = 0.016) and anti-Sm (46.8% vs. 60.6%, P = 0.036) compared to those with early-onset adult SLE. At the time of initial diagnosis, the presence of anti-R52 antibody in patients with juvenile-onset SLE was higher than in those with early-onset adult SLE (25.7% vs. 54.6%, P = 0.004). Malar rash was more common as an initial symptom in patients with juvenile-onset SLE, while interstitial lung disease was more prevalent in those with late-onset SLE. Conclusions Late-onset SLE patients exhibited more severe kidney damage and a higher likelihood of infection. Early-onset adult SLE patients had a higher likelihood of elevated disease activity. Late-onset patients with a speckled ANA pattern were more prone to developing Raynaud's phenomenon. It is important for early-onset adult SLE patients with a homogeneous ANA pattern to be vigilant about the possibility of renal disorders and skin involvement. These novel findings contribute to the diagnosis and prevention of SLE.