{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T16:40:14Z","timestamp":1776184814312,"version":"3.50.1"},"reference-count":30,"publisher":"Walter de Gruyter GmbH","issue":"4","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_rir-2025-0028_s_006\">\n                    <jats:title>Background and Objective<\/jats:title>\n                    <jats:p>Systemic lupus erythematosus (SLE) is a complex, heterogeneous autoimmune disease whose presentation can vary widely with patient age. While SLE in young adults has been extensively characterized, less is known about phenotypes of late-onset SLE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_rir-2025-0028_s_007\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study aimed to characterize the features of late-onset SLE patients in a Chinese cross-sectional study. Patients diagnosed with SLE at age 50 years or older were classified as having late-onset SLE. Early-onset SLE patients from the same cohort were included as controls. Demographic, clinical, and laboratory data were collected, and a two-step cluster analysis was employed to categorize late-onset SLE patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_rir-2025-0028_s_008\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 141 patients (27.48%) were classified as late-onset SLE. The onset of lupus in late-onset patients is more insidious, they exhibited lower systemic lupus erythematosus disease activity index-2000 (SLEDAI-2K) scores, and had significantly fewer instances of fever, mucocutaneous, and positive of antibodies compared to early-onset SLE (all\n                      <jats:italic>P<\/jats:italic>\n                      values &lt; 0.05). However, late-onset SLE patients had a higher prevalence of comorbidities, particularly Sj\u00f6gren\u2019s syndrome (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001). Additionally, late-onset SLE was associated with a high frequency of interstitial lung disease (ILD) and thrombotic events (\n                      <jats:italic>P &lt;<\/jats:italic>\n                      0.001,\n                      <jats:italic>P &lt;<\/jats:italic>\n                      0.001; respectively). Two distinct clusters of late-onset SLE patients were identified. Cluster 1 was characterized by the presence of SLE-specific autoantibodies such as anti-double stranded DNA (anti-dsDNA), anti-Smith (anti-Sm) with higher SLEDAI-2K scores (11.8 \u00b1 5.2). In contrast, cluster 2 presented with a high frequency of anti-Sj\u00f6gren syndrome antigen A (anti-SSA) antibodies and Sj\u00f6gren\u2019s syndrome with a significantly lower SLEDAI-2K scores (8.8 \u00b1 5.4) at diagnosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_rir-2025-0028_s_009\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study refines our understanding of late-onset SLE by delineating two subgroups and suggests that age-stratified approaches to diagnosis and management may improve patient care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/rir-2025-0028","type":"journal-article","created":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T08:23:15Z","timestamp":1766823795000},"page":"232-239","source":"Crossref","is-referenced-by-count":1,"title":["Unveiling the dual nature of late-onset systemic lupus erythematosus: A cross-sectional study"],"prefix":"10.1515","volume":"6","author":[{"given":"Fengyun","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Rheumatology, The First Affiliated Hospital with Nanjing Medical University , Nanjing , Jiangsu Province , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongyu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, The First Affiliated Hospital with Nanjing Medical University , Nanjing , Jiangsu Province , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoxuan","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, The First Affiliated Hospital with Nanjing Medical University , Nanjing , Jiangsu Province , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3079-6383","authenticated-orcid":false,"given":"Qiang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, The First Affiliated Hospital with Nanjing Medical University , Nanjing , Jiangsu Province , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0300-7211","authenticated-orcid":false,"given":"Chun","family":"Ouyang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The First Affiliated Hospital with Nanjing Medical University , Nanjing , Jiangsu Province , China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2025,12,27]]},"reference":[{"key":"2025122708231027516_j_rir-2025-0028_ref_001","doi-asserted-by":"crossref","unstructured":"Piga M, Tselios K, Viveiros L, et al. Clinical patterns of disease: From early systemic lupus erythematosus to late-onset disease. Best Pract Res Clin Rheumatol. 2023;37:101938.","DOI":"10.1016\/j.berh.2024.101938"},{"key":"2025122708231027516_j_rir-2025-0028_ref_002","doi-asserted-by":"crossref","unstructured":"Riveros Frutos A, Holgado S, Sanvisens Berg\u00e9 A, et al. Late-onset versus early-onset systemic lupus: characteristics and outcome in a national multicentre register (RELESSER). Rheumatology (Oxford). 2021;60:1793\u20131803.","DOI":"10.1093\/rheumatology\/keaa477"},{"key":"2025122708231027516_j_rir-2025-0028_ref_003","doi-asserted-by":"crossref","unstructured":"Sohn IW, Joo YB, Won S, et al. Late-onset systemic lupus erythematosus: Is it \u201cmild lupus\u201d? Lupus. 2018;27:235\u2013242.","DOI":"10.1177\/0961203317716789"},{"key":"2025122708231027516_j_rir-2025-0028_ref_004","doi-asserted-by":"crossref","unstructured":"Kang JH, Park DJ, Lee KE, et al. Comparison of clinical, serological, and prognostic differences among juvenile-, adult-, and late-onset lupus nephritis in Korean patients. Clin Rheumatol. 2017;36:1289\u20131295.","DOI":"10.1007\/s10067-017-3641-6"},{"key":"2025122708231027516_j_rir-2025-0028_ref_005","doi-asserted-by":"crossref","unstructured":"Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40:1725.","DOI":"10.1002\/art.1780400928"},{"key":"2025122708231027516_j_rir-2025-0028_ref_006","doi-asserted-by":"crossref","unstructured":"Petri M, Orbai AM, Alarc\u00f3n GS, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012;64:2677\u20132686.","DOI":"10.1002\/art.34473"},{"key":"2025122708231027516_j_rir-2025-0028_ref_007","doi-asserted-by":"crossref","unstructured":"Raghu G, Collard HR, Egan JJ, et al. An official ATS\/ERS\/JRS\/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183:788\u2013824.","DOI":"10.1164\/rccm.2009-040GL"},{"key":"2025122708231027516_j_rir-2025-0028_ref_008","unstructured":"Humbert M, Kovacs G, Hoeper MM, et al. Linee guida ESC\/ERS 2022 per la diagnosi e il trattamento dell\u2019ipertensione polmonare [2022 ESC\/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension]. G Ital Cardiol (Rome). 2023;24:e1-e116."},{"key":"2025122708231027516_j_rir-2025-0028_ref_009","unstructured":"Dafna D Gladman, Dominique Iba\u00f1ez, Murray B Urowitz. Systemic lupus erythematosus disease activity index 2000. J Rheumatol. 2002;29:288\u2013291."},{"key":"2025122708231027516_j_rir-2025-0028_ref_010","unstructured":"Piga M, Chessa E, Morand EF, et al. Physician Global Assessment International Standardisation COnsensus in Systemic Lupus Erythematosus: the PISCOS study. Lancet Rheumatol. 2022;4:e441\u2013e449."},{"key":"2025122708231027516_j_rir-2025-0028_ref_011","doi-asserted-by":"crossref","unstructured":"Zhao DT, Yan HP, Liao HY, et al. Using two-step cluster analysis to classify inpatients with primary biliary cholangitis based on autoantibodies: A real-world retrospective study of 537 patients in China. Front Immunol. 2023;13:1098076.","DOI":"10.3389\/fimmu.2022.1098076"},{"key":"2025122708231027516_j_rir-2025-0028_ref_012","doi-asserted-by":"crossref","unstructured":"Artim-Esen B, \u00c7ene E, \u015eahinkaya Y, et al. Cluster analysis of autoantibodies in 852 patients with systemic lupus erythematosus from a single center. J Rheumatol. 2014;41:1304\u20131310.","DOI":"10.3899\/jrheum.130984"},{"key":"2025122708231027516_j_rir-2025-0028_ref_013","doi-asserted-by":"crossref","unstructured":"Tischendorf T, Geithner S, Schaal T. Views on the well-being of groups of informal caregivers. A cluster analysis using the example of Saxony. BMC Nurs. 2024;23:912.","DOI":"10.1186\/s12912-024-02576-7"},{"key":"2025122708231027516_j_rir-2025-0028_ref_014","doi-asserted-by":"crossref","unstructured":"Yinon R, Shaul S. Cognitive-Linguistic Profiles Underlying Reading Difficulties Within the Unique Characteristics of Hebrew Language and Writing System. Dyslexia. 2025;31:e1799.","DOI":"10.1002\/dys.1799"},{"key":"2025122708231027516_j_rir-2025-0028_ref_015","doi-asserted-by":"crossref","unstructured":"Ambrose N, Morgan TA, Galloway J, et al. Differences in disease phenotype and severity in SLE across age groups. Lupus. 2016;25:1542\u20131550.","DOI":"10.1177\/0961203316644333"},{"key":"2025122708231027516_j_rir-2025-0028_ref_016","doi-asserted-by":"crossref","unstructured":"Choi JH, Park DJ, Kang JH, et al. Comparison of clinical and serological differences among juvenile-, adult-, and late-onset systemic lupus erythematosus in Korean patients. Lupus. 2015;24:1342\u20131349.","DOI":"10.1177\/0961203315591024"},{"key":"2025122708231027516_j_rir-2025-0028_ref_017","doi-asserted-by":"crossref","unstructured":"Alonso MD, Martinez-Vazquez F, de Teran TD, et al. Late-onset systemic lupus erythematosus in Northwestern Spain: differences with early-onset systemic lupus erythematosus and literature review. Lupus. 2012;21:1135\u20131148.","DOI":"10.1177\/0961203312450087"},{"key":"2025122708231027516_j_rir-2025-0028_ref_018","doi-asserted-by":"crossref","unstructured":"Medlin JL, Hansen KE, McCoy SS, et al. Pulmonary manifestations in late versus early systemic lupus erythematosus: A systematic review and meta-analysis. Semin Arthritis Rheum. 2018;48:198\u2013204.","DOI":"10.1016\/j.semarthrit.2018.01.010"},{"key":"2025122708231027516_j_rir-2025-0028_ref_019","doi-asserted-by":"crossref","unstructured":"Viveiros L, Neves A, Gouveia T, et al. A large cohort comparison of very late-onset systemic lupus erythematosus with younger-onset patients. Clin Exp Rheumatol. 2024;42:1480\u20131486.","DOI":"10.55563\/clinexprheumatol\/jgsyos"},{"key":"2025122708231027516_j_rir-2025-0028_ref_020","doi-asserted-by":"crossref","unstructured":"Wilson HA, Hamilton ME, Spyker DA, et al. Age influences the clinical and serologic expression of systemic lupus erythematosus. Arthritis Rheum. 1981;24:1230\u20131235.","DOI":"10.1002\/art.1780241002"},{"key":"2025122708231027516_j_rir-2025-0028_ref_021","doi-asserted-by":"crossref","unstructured":"Livingston B, Bonner A, Pope J. Differences in clinical manifestations between childhood-onset lupus and adult-onset lupus: a meta-analysis. Lupus. 2011;20:1345\u20131355.","DOI":"10.1177\/0961203311416694"},{"key":"2025122708231027516_j_rir-2025-0028_ref_022","doi-asserted-by":"crossref","unstructured":"R Cervera, M A Khamashta, J Font, et al. Systemic lupus erythematosus: clinical and immunologic patterns of disease expression in a cohort of 1,000 patients. The European Working Party on Systemic Lupus Erythematosus. Medicine (Baltimore). 1993;72:113\u2013124.","DOI":"10.1097\/00005792-199303000-00005"},{"key":"2025122708231027516_j_rir-2025-0028_ref_023","unstructured":"Prevete I, Iuliano A, Cauli A, et al. Similarities and differences between younger and older disease onset patients with newly diagnosed systemic lupus erythematosus. Clin Exp Rheumatol. 2023;41:145\u2013150."},{"key":"2025122708231027516_j_rir-2025-0028_ref_024","doi-asserted-by":"crossref","unstructured":"Sassi RH, Hendler JV, Piccoli GF, et al. Age of onset influences on clinical and laboratory profile of patients with systemic lupus erythematosus. Clin Rheumatol. 2017;36:89\u201395.","DOI":"10.1007\/s10067-016-3478-4"},{"key":"2025122708231027516_j_rir-2025-0028_ref_025","doi-asserted-by":"crossref","unstructured":"Kato Y, Park J, Takamatsu H, et al. Apoptosis-derived membrane vesicles drive the cGAS-STING pathway and enhance type I IFN production in systemic lupus erythematosus. Ann Rheum Dis. 2018;77:1507\u20131515.","DOI":"10.1136\/annrheumdis-2018-212988"},{"key":"2025122708231027516_j_rir-2025-0028_ref_026","doi-asserted-by":"crossref","unstructured":"Chasset F, Ribi C, Trendelenburg M, et al. Identification of highly active systemic lupus erythematosus by combined type I interferon and neutrophil gene scores vs classical serologic markers. Rheumatology (Oxford). 2020;59:3468\u20133478.","DOI":"10.1093\/rheumatology\/keaa167"},{"key":"2025122708231027516_j_rir-2025-0028_ref_027","doi-asserted-by":"crossref","unstructured":"Sturfelt G, Truedsson L. Complement in the immunopathogenesis of rheumatic disease. Nat Rev Rheumatol. 2012;8:458\u2013468.","DOI":"10.1038\/nrrheum.2012.75"},{"key":"2025122708231027516_j_rir-2025-0028_ref_028","doi-asserted-by":"crossref","unstructured":"Arnaud L, Chasset F, Martin T. Immunopathogenesis of systemic lupus erythematosus: An update. Autoimmun Rev. 2024;23:103648.","DOI":"10.1016\/j.autrev.2024.103648"},{"key":"2025122708231027516_j_rir-2025-0028_ref_029","doi-asserted-by":"crossref","unstructured":"Gui X, Shenyun S, Ding H, et al. Anti-Ro52 antibodies are associated with the prognosis of adult idiopathic inflammatory myopathy-associated interstitial lung disease. Rheumatology (Oxford). 2022;61:4570\u20134578.","DOI":"10.1093\/rheumatology\/keac090"},{"key":"2025122708231027516_j_rir-2025-0028_ref_030","doi-asserted-by":"crossref","unstructured":"Wang Z, Li M, Ye Z, et al. Long-term Outcomes of Patients with Systemic Lupus Erythematosus: A Multicenter Cohort Study from CSTAR Registry. Rheumatol Immunol Res. 2021;2:195\u2013 202.","DOI":"10.2478\/rir-2021-0025"}],"container-title":["Rheumatology and Immunology Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/rir-2025-0028\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/rir-2025-0028\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T08:23:23Z","timestamp":1766823803000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/rir-2025-0028\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,1]]},"references-count":30,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12,27]]},"published-print":{"date-parts":[[2025,12,27]]}},"alternative-id":["10.1515\/rir-2025-0028"],"URL":"https:\/\/doi.org\/10.1515\/rir-2025-0028","relation":{},"ISSN":["2719-4523"],"issn-type":[{"value":"2719-4523","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,1]]}}}