Late-Onset Systemic Lupus Erythematosus: Is It Really a Benign Disease?

Late-onset systemic lupus erythematosus (LO-SLE), typically defined as disease onset at or after 50 years of age, represents a recognized clinical subset of systemic lupus erythematosus with distinctive features. Compared with earlier-onset disease, LO-SLE often presents with a more insidious onset and a somewhat different clinical profile, in which renal and mucocutaneous involvement may be less prominent, whereas serositis, constitutional manifestations, and interstitial lung involvement are more commonly encountered. Immunosenescence is believed to contribute to the pathophysiology of LO-SLE through its effects on both innate and adaptive immune responses. From a serological standpoint, patients in this subgroup may less frequently exhibit anti-double-stranded DNA antibodies and more often demonstrate anti-SSA/Ro and anti-SSB/La antibodies, which can result in clinical and immunological overlap with Sjögren's disease and create diagnostic complexity. Diagnosis is commonly guided by the 2019 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria; however, careful clinical assessment remains essential in older adults due to reduced specificity of antinuclear antibodies and the frequent presence of comorbidities. Management should be individualized, with particular attention to safety, maintaining hydroxychloroquine as the cornerstone of therapy and using glucocorticoids and other immunomodulatory agents cautiously according to disease activity and organ involvement.