What Women Over Age 50 Need to Know About Late-Onset Lupus

By Adrienne Hollander, MD, Virtua Rheumatologist

The immune system is the part of your body that normally helps fight off colds and infections. But, when it misbehaves, it can mistakenly attack your healthy body and make it sick. Groups of diseases that act in this way are called autoimmune diseases.

What is lupus?

Some autoimmune diseases, such as psoriasis, specifically affect one body part (psoriasis tends to be limited to the skin). A systemic autoimmune disease affects many organs or tissues in the body.

Lupus is a systemic autoimmune disease characterized by an immune attack on various tissues. This includes, but is not limited to, the skin, muscles, bones, blood, and kidneys. Although the severity and symptoms of the disease can vary from person to person, some may experience a facial “butterfly” rash (called malar rash), fever, joint pain, and/or fatigue.

The cause of lupus is unknown but genetics, hormones and environmental factors may play a role in triggering the disease.

What makes late-onset lupus different?

In the United States, the prevalence of lupus is higher in African Americans, Asians, African Caribbeans and Hispanic Americans compared to Caucasians. In 65% of patients, symptoms appear between the ages of 16-55, and the ratio of women to men is 15:1.

By contrast, late-onset lupus affects women about 8 times more frequently than men—and mainly Caucasian women. Symptoms begin to develop more gradually and are milder after age 50. Late-onset lupus progresses slowly, so proper diagnosis may take more time and testing.

Late-onset lupus patients also experience slightly different symptoms including:

• A lower incidence of malar rash
• Kidney issues that appear sooner than in early-onset lupus
• Dry eyes
• Muscle and joint pain

Blood tests assist your doctor in making the right diagnosis, as some of the lupus blood-test markers are different in late-onset lupus compared to early-onset lupus.

What changes with age?

There are theories about why some people get lupus at a later age. These theories include concerns about how certain drugs are used to treat common age-related illnesses. In addition, many components of the immune system slow down or don’t work as efficiently when you reach a certain age. 

It’s also thought that perimenopause, and the associated hormonal changes, contribute to the development of lupus.  

What’s in store for someone who has been diagnosed with late-onset lupus?

There are varying degrees of lupus that can affect your individual outcome. The diagnosis may be mild, moderate, or severe. A more severe diagnosis requires stronger medicines, such as immunosuppressants, which suppress the immune system to help control symptoms.

The good news is that the medicines work well, especially when the disease is caught early. Contact your physician or rheumatologist if you have questions about symptoms you may be experiencing, or about diagnostic testing and treatment options. 

Updated January 14, 2022