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Late-Onset SLE — SCE Rheumatology MCQ

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ModerateSLE & Antiphospholipid SyndromeLate-Onset SLESCE Rheumatology

A 65-year-old man developed his first manifestations of systemic lupus erythematosus (SLE) at age 63. Compared with younger-onset SLE, which pattern is most characteristic of late-onset SLE?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Serositis is more frequent, whereas skin rash, renal involvement and anti-dsDNA positivity are less frequent

Explanation lettering: D = shown as A · E = shown as B · A = shown as D · B = shown as E

Option C is correct. Late-onset SLE is conventionally defined by disease onset at or after 50 years. Compared with younger-onset disease, it more often features serositis but less often has prominent mucocutaneous disease, lupus nephritis, neuropsychiatric involvement or anti-dsDNA positivity. Therefore, options A, B and D contain reversed associations, particularly for serositis, rash or renal disease, while E incorrectly suggests that age at onset does not modify the phenotype. Late-onset SLE includes both sexes, although the female predominance is less marked. Its apparently lower inflammatory activity should not be equated with benign disease: diagnosis may be delayed, and age-related comorbidity, treatment toxicity and irreversible organ damage can contribute to poorer outcomes.

Reference: Sakurai N, Yoshimi R, Nakajima H. Characteristics of Late-Onset Systemic Lupus Erythematosus: Clinical Manifestations and Diagnostic and Treatment Challenges. Drugs & Aging. 2025;42:1001–1009. https://pubmed.ncbi.nlm.nih.gov/40952616/