{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:42:42Z","timestamp":1787499762858,"version":"build-2736575974"},"reference-count":97,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T00:00:00Z","timestamp":1744070400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease predominantly affecting young individuals; however, its late-onset manifestation poses distinct clinical and diagnostic challenges. Methods: This report describes the case of a 93-year-old patient who presented in the Emergency Department with exertional dyspnea, lower limb edema, fatiguability, diffuse abdominal pain, predominantly in the hypogastric region, and loss of appetite. Results: Based on the clinical examination, laboratory tests, and imagistic investigations, we excluded the most common etiologies of edema (decompensated chronic heart failure, glomerular nephropathy\/chronic kidney disease, decompensated vascular cirrhosis, hypothyroidism, and hypoproteinemia). Further diagnostic evaluation revealed elevated levels of anti-nuclear antibodies and anti-dsDNA antibodies, along with reduced complement levels, indicating active SLE as the underlying cause of the patient\u2019s edema. During hospitalization, the patient received corticosteroid therapy and, after discharge, was referred to the Rheumatology Department for further treatment. Conclusions: In elderly patients, late-onset SLE exhibits distinct clinical manifestations compared to its early-onset counterpart, likely due to age-related alterations in immune system function.<\/jats:p>","DOI":"10.3390\/jcm14082558","type":"journal-article","created":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T03:32:53Z","timestamp":1744169573000},"page":"2558","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Systemic Lupus Erythematosus Features in Elderly Patients: Case-Based Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0043-9051","authenticated-orcid":false,"given":"Alexandr","family":"Ceasovschih","sequence":"first","affiliation":[{"name":"Faculty of Medicine, \u2018Grigore T. Popa\u2019 University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Internal Medicine Clinic, \u2018Sf. Spiridon\u2019 Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5272-8649","authenticated-orcid":false,"given":"Raluca-Elena","family":"Alexa","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u2018Grigore T. Popa\u2019 University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Internal Medicine Clinic, \u2018Sf. Spiridon\u2019 Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1721-2360","authenticated-orcid":false,"given":"Victori\u021ba","family":"\u0218orodoc","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u2018Grigore T. Popa\u2019 University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Internal Medicine Clinic, \u2018Sf. Spiridon\u2019 Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5567-8746","authenticated-orcid":false,"given":"Andreea","family":"Asaftei","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u2018Grigore T. Popa\u2019 University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Internal Medicine Clinic, \u2018Sf. Spiridon\u2019 Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denisa Cristiana","family":"Stoian","sequence":"additional","affiliation":[{"name":"2nd Internal Medicine Clinic, \u2018Sf. Spiridon\u2019 Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca Codrina","family":"Mor\u0103ra\u0219u","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u2018Grigore T. Popa\u2019 University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Internal Medicine Clinic, \u2018Sf. Spiridon\u2019 Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1550-0262","authenticated-orcid":false,"given":"Anastasia","family":"Balta","sequence":"additional","affiliation":[{"name":"2nd Internal Medicine Clinic, \u2018Sf. Spiridon\u2019 Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0525-0645","authenticated-orcid":false,"given":"C\u0103t\u0103lina","family":"Lionte","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u2018Grigore T. Popa\u2019 University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Internal Medicine Clinic, \u2018Sf. Spiridon\u2019 Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5024-3030","authenticated-orcid":false,"given":"Alexandra","family":"Stoica","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u2018Grigore T. Popa\u2019 University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Internal Medicine Clinic, \u2018Sf. Spiridon\u2019 Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3994-2356","authenticated-orcid":false,"given":"Oana","family":"S\u00eerbu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u2018Grigore T. Popa\u2019 University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Internal Medicine Clinic, \u2018Sf. Spiridon\u2019 Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6884-1524","authenticated-orcid":false,"given":"Mihai","family":"Constantin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u2018Grigore T. Popa\u2019 University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Internal Medicine Clinic, \u2018Sf. Spiridon\u2019 Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra-Diana","family":"Diaconu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u2018Grigore T. Popa\u2019 University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Internal Medicine Clinic, \u2018Sf. Spiridon\u2019 Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9012-5901","authenticated-orcid":false,"given":"Cristina-Mihaela","family":"L\u0103c\u0103tu\u0219u","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u2018Grigore T. Popa\u2019 University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Unit of Diabetes, Nutrition, and Metabolic Diseases, \u2018Sf. Spiridon\u2019 Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7721-554X","authenticated-orcid":false,"given":"Elena-Daniela","family":"Grigorescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u2018Grigore T. Popa\u2019 University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Unit of Diabetes, Nutrition, and Metabolic Diseases, \u2018Sf. Spiridon\u2019 Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren\u021biu","family":"\u0218orodoc","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u2018Grigore T. Popa\u2019 University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Internal Medicine Clinic, \u2018Sf. Spiridon\u2019 Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1136\/annrheumdis-2018-214819","article-title":"2019 European League Against Rheumatism\/American College of Rheumatology classification criteria for systemic lupus erythematosus","volume":"78","author":"Aringer","year":"2019","journal-title":"Ann. Rheum. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"103648","DOI":"10.1016\/j.autrev.2024.103648","article-title":"Immunopathogenesis of systemic lupus erythematosus: An update","volume":"23","author":"Arnaud","year":"2024","journal-title":"Autoimmun. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.2169\/internalmedicine.1886-18","article-title":"Bilateral Pleuritis as the Initial Symptom of Systemic Lupus Erythematosus: A Case Series and Literature Review","volume":"58","author":"So","year":"2019","journal-title":"Intern. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1002\/jgf2.157","article-title":"Severe pleuritis and pericarditis associated with very-late-onset systemic lupus erythematosus","volume":"19","author":"Ikushima","year":"2018","journal-title":"J. Gen. Fam. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1793","DOI":"10.1093\/rheumatology\/keaa477","article-title":"Late-onset versus early-onset systemic lupus: Characteristics and outcome in a national multicentre register (RELESSER)","volume":"60","author":"Frutos","year":"2021","journal-title":"Rheumatology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"23247096221089493","DOI":"10.1177\/23247096221089493","article-title":"Polymyalgia Rheumatica or Late Onset Lupus? A Case Report","volume":"10","author":"Altier","year":"2022","journal-title":"J. Investig. Med. High Impact Case Rep."},{"key":"ref_7","first-page":"e46428","article-title":"A Case of Late-Onset Systemic Lupus Erythematosus With Systemic Symptoms Leading to Multiple Organ Failure","volume":"15","author":"Hasegawa","year":"2023","journal-title":"Cureus"},{"key":"ref_8","first-page":"e30330","article-title":"An Overview of Systemic Lupus Erythematosus (SLE) Pathogenesis, Classification, and Management","volume":"14","author":"Ameer","year":"2022","journal-title":"Cureus"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3025","DOI":"10.2169\/internalmedicine.0934-18","article-title":"Reversible Cognitive Dysfunction in Elderly-onset Systemic Lupus Erythematosus, Successfully Treated with Aggressive Immunosuppressive Therapy","volume":"57","author":"Fujita","year":"2018","journal-title":"Intern. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/1755-7682-6-3","article-title":"Late-onset systemic lupus erythematosus-associated primary biliary cirrhosis","volume":"6","author":"Hammami","year":"2013","journal-title":"Int. Arch. Med."},{"key":"ref_11","first-page":"1480","article-title":"A large cohort comparison of very late-onset systemic lupus erythematosus with younger-onset patients","volume":"42","author":"Viveiros","year":"2024","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"497","DOI":"10.20452\/pamw.2947","article-title":"Late-onset systemic lupus erythematosus: Clinical manifestations, course, and prognosis","volume":"125","year":"2015","journal-title":"Pol. Arch. Med. Wewn."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.jdcr.2024.08.015","article-title":"Subacute cutaneous lupus erythematosus following osimertinib therapy for non-small cell lung cancer: A case report","volume":"53","author":"Kim","year":"2024","journal-title":"JAAD Case Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"15579883241293781","DOI":"10.1177\/15579883241293781","article-title":"Late-Onset Familial Systemic Lupus Erythematosus With Lupus Nephritis in an 82-Year-Old Male: A Case Report and Literature Review","volume":"18","author":"Mrabet","year":"2024","journal-title":"Am. J. Mens. Health"},{"key":"ref_15","first-page":"e63327","article-title":"Unilateral Pleural Effusion as an Initial Manifestation of Systemic Lupus Erythematosus in a Patient of Advanced Age","volume":"16","author":"Tsuji","year":"2024","journal-title":"Cureus"},{"key":"ref_16","first-page":"e69812","article-title":"Systemic Lupus Erythematosus in a Nonagenarian Woman: A Case Report","volume":"16","year":"2024","journal-title":"Cureus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2267","DOI":"10.1111\/1756-185X.14767","article-title":"Serositis and lymphopenia are common features of systemic lupus erythematosus following SARS-CoV-2 infection: A case report and literature review","volume":"26","author":"Kioi","year":"2023","journal-title":"Int. J. Rheum. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2633","DOI":"10.1016\/j.jfma.2022.03.020","article-title":"Rare cause of ascites and pleural effusion: The first case report and literature review of pseudo-pseudo Meig\u2019s syndrome in Taiwan","volume":"121","author":"Chao","year":"2022","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e6966","DOI":"10.1002\/ccr3.6966","article-title":"Fulminant lupus pneumonitis complicating systemic lupus erythematosus in the elderly","volume":"11","author":"Helali","year":"2023","journal-title":"Clin. Case Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"707","DOI":"10.12998\/wjcc.v9.i3.707","article-title":"Systemic lupus erythematosus and antineutrophil cytoplasmic antibody-associated vasculitis overlap syndrome in a 77-year-old man: A case report","volume":"9","author":"Xu","year":"2021","journal-title":"World J. Clin. Cases"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e932959","DOI":"10.12659\/AJCR.932959","article-title":"Late-Onset Systemic Lupus Erythematosus Associated with Autoimmune Hemolytic Anemia and Sixth Cranial Nerve Palsy","volume":"22","author":"Kuroda","year":"2021","journal-title":"Am. J. Case Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"121","DOI":"10.37897\/RJR.2021.3.6","article-title":"Features of Late-Onset Systemic Lupus Erythematosus","volume":"30","author":"Constantinescu","year":"2021","journal-title":"Rom. J. Rheumatol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Bao, D., Tan, Y., Yu, X., Wang, B., Wang, H., Xu, R., Zhou, F., and Zhao, M. (2021). Case Report: A Rare Case of Lupus Nephritis Associated With Mantle Cell Lymphoma. Front. Med., 8.","DOI":"10.3389\/fmed.2021.759279"},{"key":"ref_24","first-page":"001734","article-title":"Angioimmunoblastic T-cell Lymphoma: A Mimic for Lupus","volume":"7","author":"Tay","year":"2020","journal-title":"Eur. J. Case Rep. Intern. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s00393-020-00926-9","article-title":"Paraneoplastischer subakut kutaner Lupus erythematodes","volume":"80","author":"Rezazadegan","year":"2021","journal-title":"Z. Rheumatol."},{"key":"ref_26","first-page":"9695","article-title":"The first case of systemic lupus erythematosus (SLE) triggered by COVID-19 infection","volume":"24","author":"Bonometti","year":"2020","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_27","first-page":"001570","article-title":"Very Late-Onset Systemic Lupus Erythematosus as Unusual Cause of Reversible Functional and Cognitive Impairments in an Octogenarian Patient","volume":"7","author":"Boland","year":"2020","journal-title":"Eur. J. Case Rep. Intern. Med."},{"key":"ref_28","first-page":"63","article-title":"Pulmonary Manifestations of Late-Onset Systemic Lupus Erythematosus: A Case Report","volume":"4","author":"Kalenchic","year":"2019","journal-title":"Revmatologiia"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e12871","DOI":"10.1097\/MD.0000000000012871","article-title":"Diagnosis of systemic lupus erythematosus by presence of Hargraves cells in eosinophilic pleural effusion: Case report","volume":"97","author":"Peillet","year":"2018","journal-title":"Medicine"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"bcr2017224094","DOI":"10.1136\/bcr-2017-224094","article-title":"Bronchiolitis obliterans organising pneumonia as an initial manifestation in a patient with systemic lupus erythematosus: A rare presentation","volume":"2018","author":"Jatwani","year":"2018","journal-title":"BMJ Case Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e13545","DOI":"10.1097\/MD.0000000000013545","article-title":"Progression of immunoglobulin G4-related disease to systematic lupus erythematosus after gastric cancer surgery: A case report","volume":"97","author":"Arai","year":"2018","journal-title":"Medicine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1080\/24725625.2017.1291299","article-title":"Two cases of very elderly onset male lupus patient; the characteristics and sex differences of elderly onset systemic lupus erythematosus patients","volume":"1","author":"Shirai","year":"2017","journal-title":"Mod. Rheumatol. Case"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1159\/000448392","article-title":"Diffuse Bullous Eruptions in an Elderly Woman: Late-Onset Bullous Systemic Lupus Erythematosus","volume":"8","author":"Boddu","year":"2016","journal-title":"Case Rep. Dermatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"783","DOI":"10.2169\/internalmedicine.55.5635","article-title":"Combined Pulmonary Fibrosis and Emphysema Preceding Lupus Pleuritis","volume":"55","author":"Kamiya","year":"2016","journal-title":"Intern. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"165","DOI":"10.11604\/pamj.2014.18.165.2080","article-title":"Successful treatment of massive ascites due to lupus peritonitis with hydroxychloroquine in old- onset lupus erythematosus","volume":"18","author":"Hammami","year":"2014","journal-title":"Pan Afr. Med. J."},{"key":"ref_36","first-page":"104","article-title":"Lupus eritematoso sist\u00e9mico en el anciano: Una presentaci\u00f3n at\u00edpica de una enfermedad com\u00fan","volume":"21","author":"Aguirre","year":"2014","journal-title":"Rev. Colomb. Reumatol."},{"key":"ref_37","first-page":"311","article-title":"Pulmonary fibrosis revealing systemic lupus erythematosus in an elderly subject","volume":"18","author":"Chebbi","year":"2014","journal-title":"Pan Afr. Med. J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"S15","DOI":"10.1007\/s10067-007-0811-y","article-title":"Elderly onset systemic lupus erythematosus (SLE) presenting with disseminated intravascular coagulation (DIC)","volume":"27","author":"Iyoda","year":"2008","journal-title":"Clin. Rheumatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.2169\/internalmedicine.41.1056","article-title":"Chronic lupus peritonitis with massive ascites at elderly onset: Case report and review of the literature","volume":"41","author":"Ito","year":"2002","journal-title":"Intern. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1007\/BF02243008","article-title":"Autoimmune Multiorgan Involvement in Elderly Men Is It SLE?","volume":"13","author":"Aharon","year":"1994","journal-title":"Clin. Rheumatol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1007\/s00011-022-01554-6","article-title":"Role of the innate and adaptive immune responses in the pathogenesis of systemic lupus erythematosus","volume":"71","author":"Bolouri","year":"2022","journal-title":"Inflamm. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"105627","DOI":"10.1016\/j.jbspin.2023.105627","article-title":"Type 1 interferons: A target for immune-mediated inflammatory diseases (IMIDs)","volume":"91","author":"Mathian","year":"2024","journal-title":"Jt. Bone Spine"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Goyani, P., Christodoulou, R., and Vassiliou, E. (2024). Immunosenescence: Aging and Immune System Decline. Vaccines, 12.","DOI":"10.3390\/vaccines12121314"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1590\/S1807-59322010000300014","article-title":"The role of apoptosis proteins and complement components in the etiopathogenesis of systemic lupus erythematosus","volume":"65","author":"Liphaus","year":"2010","journal-title":"Clinics"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1038\/nrrheum.2016.186","article-title":"New insights into the immunopathogenesis of systemic lupus erythematosus","volume":"12","author":"Tsokos","year":"2016","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.clim.2016.07.015","article-title":"Toll-like receptor activation in the pathogenesis of lupus nephritis","volume":"185","author":"Lorenz","year":"2017","journal-title":"Clin. Immunol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2992","DOI":"10.1093\/rheumatology\/keaa060","article-title":"Inhibition of mTOR suppresses IFN\u03b1 production and the STING pathway in monocytes from systemic lupus erythematosus patients","volume":"59","author":"Murayama","year":"2020","journal-title":"Rheumatology"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1136\/annrheumdis-2018-212988","article-title":"Apoptosis-derived membrane vesicles drive the cGAS-STING pathway and enhance type I IFN production in systemic lupus erythematosus","volume":"77","author":"Kato","year":"2018","journal-title":"Ann. Rheum. Dis."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1038\/s41423-018-0024-0","article-title":"NETosis, complement, and coagulation: A triangular relationship","volume":"16","author":"Boelens","year":"2019","journal-title":"Cell Mol. Immunol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.coi.2014.03.009","article-title":"Expanding roles of neutrophils in aging hosts","volume":"29","author":"Tseng","year":"2014","journal-title":"Curr. Opin. Immunol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.clim.2018.04.002","article-title":"Immune Senescence, Epigenetics and Autoimmunity","volume":"196","author":"Ray","year":"2018","journal-title":"Clin. Immunol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1038\/nm.4027","article-title":"Neutrophil extracellular traps enriched in oxidized mitochondrial DNA are interferogenic and contribute to lupus-like disease","volume":"22","author":"Lood","year":"2016","journal-title":"Nat. Med."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Wang, T., Mei, Y., and Li, Z. (2019). Research Progress on Regulatory B Cells in Systemic Lupus Erythematosus. BioMed Res. Int., 2019.","DOI":"10.1155\/2019\/7948687"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Hudspeth, K.L., Shu, W., Wang, J., Rahman, S., A Smith, M., Casey, K.A., Stephens, G.L., A Sanjuan, M., Team, A.M., and A Hasni, S. (2016). NK Cell Phenotype and Proliferation in Systemic Lupus Erythematosus. J. Immunol., 196.","DOI":"10.4049\/jimmunol.196.Supp.194.5"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Dossybayeva, K., Abdukhakimova, D., and Poddighe, D. (2020). Basophils and Systemic Lupus Erythematosus in Murine Models and Human Patients. Biology, 9.","DOI":"10.3390\/biology9100308"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Soni, C., and Reizis, B. (2019). Self-DNA at the Epicenter of SLE: Immunogenic Forms, Regulation, and Effects. Front. Immunol., 10.","DOI":"10.3389\/fimmu.2019.01601"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"932","DOI":"10.3904\/kjim.2017.224","article-title":"The evaluation of cellular immune function in elderly patients with systemic lupus erythematosus","volume":"34","author":"Men","year":"2019","journal-title":"Korean J. Intern. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.coi.2016.09.001","article-title":"T Cells in Systemic Lupus Erythematosus","volume":"43","author":"Bradley","year":"2016","journal-title":"Curr. Opin. Immunol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2932531","DOI":"10.1155\/2016\/2932531","article-title":"The Role of \u03b3\u03b4 T Cells in Systemic Lupus Erythematosus","volume":"2016","author":"Wu","year":"2016","journal-title":"J. Immunol. Res."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"109202","DOI":"10.1016\/j.clim.2022.109202","article-title":"T-cell senescence: A crucial player in autoimmune diseases","volume":"248","author":"Lu","year":"2023","journal-title":"Clin. Immunol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1177\/0961203317709347","article-title":"Autoantibodies against Complement Components in Systemic Lupus Erythematosus\u2014Role in the Pathogenesis and Clinical Manifestations","volume":"26","author":"Hristova","year":"2017","journal-title":"Lupus"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1038\/nrrheum.2010.56","article-title":"Are anti-C1q antibodies different from other SLE autoantibodies?","volume":"6","author":"Pickering","year":"2010","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1136\/annrheumdis-2014-205287","article-title":"The complement system in systemic lupus erythematosus: An update","volume":"73","author":"Leffler","year":"2014","journal-title":"Ann. Rheum. Dis."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e000236","DOI":"10.1136\/lupus-2017-000236","article-title":"Cell-bound complement activation products in SLE","volume":"4","author":"Li","year":"2017","journal-title":"Lupus Sci. Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.jsbmb.2010.03.058","article-title":"The role of the glucocorticoid receptor in inflammation and immunity","volume":"120","author":"Baschant","year":"2010","journal-title":"J. Steroid Biochem. Mol. Biol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.autrev.2010.11.009","article-title":"The kaleidoscope of glucorticoid effects on immune system","volume":"10","author":"Zen","year":"2011","journal-title":"Autoimmun. Rev."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1093\/ajh\/hpaa137","article-title":"Aldosterone, Inflammation, Immune System, and Hypertension","volume":"34","author":"Ferreira","year":"2021","journal-title":"Am. J. Hypertens."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Bereshchenko, O., Bruscoli, S., and Riccardi, C. (2018). Glucocorticoids, Sex Hormones, and Immunity. Front. Immunol., 9.","DOI":"10.3389\/fimmu.2018.01332"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e7179","DOI":"10.7717\/peerj.7179","article-title":"Updated advances of linking psychosocial factors and sex hormones with systemic lupus erythematosus susceptibility and development","volume":"7","author":"Pan","year":"2019","journal-title":"PeerJ"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Alberro, A., Iribarren-Lopez, A., S\u00e1enz-Cuesta, M., Matheu, A., Vergara, I., and Otaegui, D. (2021). Inflammaging markers characteristic of advanced age show similar levels with frailty and dependency. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-83991-7"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Cisneros, B., Garc\u00eda-Aguirre, I., Unzueta, J., Arrieta-Cruz, I., Gonz\u00e1lez-Morales, O., Dom\u00ednguez-Larrieta, J.M., Tamez-Gonz\u00e1lez, A., Leyva-G\u00f3mez, G., and Maga\u00f1a, J.J. (2022). Immune system modulation in aging: Molecular mechanisms and therapeutic targets. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.1059173"},{"key":"ref_72","first-page":"267078","article-title":"Immunosenescence, Aging, and Systemic Lupus Erythematous","volume":"2013","year":"2013","journal-title":"Autoimmune Dis."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1111\/j.1474-9726.2008.00443.x","article-title":"B-cell diversity decreases in old age and is correlated with poor health status","volume":"8","author":"Gibson","year":"2009","journal-title":"Aging Cell"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1007\/s10522-011-9353-4","article-title":"B cell immunosenescence: Different features of naive and memory B cells in elderly","volume":"12","author":"Buffa","year":"2011","journal-title":"Biogerontology"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"2327","DOI":"10.1182\/blood-2016-05-718999","article-title":"Aged neutrophils contribute to the first line of defense in the acute inflammatory response","volume":"128","author":"Uhl","year":"2016","journal-title":"Blood"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1038\/s41590-023-01505-1","article-title":"Age-induced alterations of granulopoiesis generate atypical neutrophils that aggravate stroke pathology","volume":"24","author":"Gullotta","year":"2023","journal-title":"Nat. Immunol."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Gubbels Bupp, M.R., Potluri, T., Fink, A.L., and Klein, S.L. (2018). The Confluence of Sex Hormones and Aging on Immunity. Front. Immunol., 9.","DOI":"10.3389\/fimmu.2018.01269"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/j.autrev.2011.10.022","article-title":"Genes, epigenetic regulation and environmental factors: Which is the most relevant in developing autoimmune diseases?","volume":"11","author":"Costenbader","year":"2012","journal-title":"Autoimmun. Rev."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1191\/0961203304lu1094oa","article-title":"Sex hormones influence on the immune system: Basic and clinical aspects in autoimmunity","volume":"13","author":"Cutolo","year":"2004","journal-title":"Lupus"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"e180076","DOI":"10.1172\/JCI180076","article-title":"Mechanisms underlying sex differences in autoimmunity","volume":"134","author":"Fairweather","year":"2024","journal-title":"J. Clin. Investig."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.clim.2018.11.013","article-title":"Reprint of The Interaction between Environmental Triggers and Epigenetics in Autoimmunity","volume":"196","author":"Richardson","year":"2018","journal-title":"Clin. Immunol"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"102468","DOI":"10.1016\/j.autrev.2020.102468","article-title":"Estrogen, estrogen-like molecules and autoimmune diseases","volume":"19","author":"Merrheim","year":"2020","journal-title":"Autoimmun. Rev."},{"key":"ref_83","first-page":"583","article-title":"Systemic Lupus Erythematosus: One Year in Review 2024","volume":"42","author":"Silvagni","year":"2024","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1136\/annrheumdis-2020-218272","article-title":"Update on the Diagnosis and Management of Systemic Lupus Erythematosus","volume":"80","author":"Fanouriakis","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1007\/s10067-019-04848-z","article-title":"Validation of the 2019 ACR\/EULAR classification criteria of systemic lupus erythematosus in 100 Japanese patients: A real-world setting analysis","volume":"39","author":"Suda","year":"2020","journal-title":"Clin. Rheumatol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"101938","DOI":"10.1016\/j.berh.2024.101938","article-title":"Clinical patterns of disease: From early systemic lupus erythematosus to late-onset disease","volume":"37","author":"Piga","year":"2023","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.autrev.2007.11.014","article-title":"Systemic lupus erythematosus in the elderly","volume":"7","year":"2008","journal-title":"Autoimmun. Rev."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1136\/ard-2023-224762","article-title":"EULAR recommendations for the management of systemic lupus erythematosus: 2023 update","volume":"83","author":"Fanouriakis","year":"2024","journal-title":"Ann. Rheum. Dis."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1177\/0961203310397563","article-title":"Late onset lupus nephritis in Chinese patients: Classified by the 2003 International Society of Nephrology and Renal Pathology Society system","volume":"20","author":"Xu","year":"2011","journal-title":"Lupus"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"2054358118793397","DOI":"10.1177\/2054358118793397","article-title":"Late-Onset Systemic Lupus Erythematosus with Lupus Nephritis in a 74-Year-Old Male: A Brief Case and Review","volume":"5","author":"Kutky","year":"2018","journal-title":"Can. J. Kidney Health Dis."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1177\/0961203317696593","article-title":"Disease evolution in late-onset and early-onset systemic lupus erythematosus","volume":"26","author":"Aljohani","year":"2017","journal-title":"Lupus"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1093\/ndt\/gfv102","article-title":"Lupus nephritis management guidelines compared","volume":"31","author":"Wilhelmus","year":"2016","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1177\/0961203314563134","article-title":"Late-onset systemic lupus erythematosus in Latin Americans: A distinct subgroup?","volume":"24","author":"Catoggio","year":"2015","journal-title":"Lupus"},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Ahn, S.S., Yoo, J., Jung, S.M., Song, J.J., Park, Y.B., and Lee, S.W. (2020). Comparison of clinical features and outcomes between patients with early and delayed lupus nephritis. BMC Nephrol., 21.","DOI":"10.1186\/s12882-020-01915-5"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s42358-019-0105-5","article-title":"Comparison of lupus patients with early and late onset nephritis: A study in 71 patients from a single referral center","volume":"60","author":"Delfino","year":"2020","journal-title":"Adv. Rheumatol."},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Zucchi, D., Cardelli, C., Elefante, E., Tani, C., and Mosca, M. (2023). Treat-to-Target in Systemic Lupus Erythematosus: Reality or Pipe Dream. J. Clin. Med., 12.","DOI":"10.3390\/jcm12093348"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1007\/s10067-013-2238-y","article-title":"Late-onset systemic lupus erythematosus: Clinical features, course, and prognosis","volume":"32","author":"Petrovic","year":"2013","journal-title":"Clin. Rheumatol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/8\/2558\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:12:43Z","timestamp":1760029963000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/8\/2558"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,8]]},"references-count":97,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["jcm14082558"],"URL":"https:\/\/doi.org\/10.3390\/jcm14082558","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,8]]}}}