Pulmonary manifestations in late versus early systemic lupus erythematosus: A systematic review and meta-analysis

Jennifer L. Medlin, Karen E. Hansen, Sara S. McCoy, Christie M. Bartels

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objectives: Phenotypes differ between late- and early-onset systemic lupus erythematosus (SLE). Prior studies suggested that there may be more pulmonary disease among late-onset patients. Our objective was to perform a systematic review and meta-analysis to evaluate the differences in pulmonary manifestations in late- versus early-onset SLE. Methods: We searched the literature using PubMed, CINAHL, Web of Science, Cochrane Library, and EMBASE. We excluded studies that did not include American College of Rheumatology SLE classification criteria, an early-onset SLE comparison group, or those that defined late-onset SLE as <50 years of age. We rated study quality using the Newcastle–Ottawa Quality Scale. We used Forest plots to compare odds ratios (95% confidence intervals) of pulmonary manifestations by age. Study heterogeneity was assessed using I2. Results: Thirty-nine studies, representing 10,963 early-onset and 1656 late-onset patients with SLE, met eligibility criteria. The odds of developing several pulmonary manifestations were higher in the late-onset group. Interstitial lung disease (ILD) was nearly three times more common (OR = 2.56 (1.27, 5.16)). Pleuritis (OR = 1.53 (1.19, 1.96)) and serositis (OR = 1.31 (1.05, 1.65)) were also more common in the late-onset group. The mean Newcastle–Ottawa Quality Scale score for study quality was moderate (6.3 ± 0.7, scale 0–9). Conclusions: Pulmonary manifestations of SLE were more common in late-onset SLE patients compared to their younger peers, in particular ILD and serositis. Age-related changes of the immune system, tobacco exposure, race, and possible overlap with Sjögren's syndrome should be examined in future studies.

Original languageEnglish (US)
Pages (from-to)198-204
Number of pages7
JournalSeminars in Arthritis and Rheumatism
Issue number2
StatePublished - Oct 2018
Externally publishedYes


  • Interstitial lung disease (ILD)
  • Pleuritis
  • Pulmonary manifestations
  • Serositis
  • Systemic lupus erythematosus (SLE)

ASJC Scopus subject areas

  • Rheumatology
  • Anesthesiology and Pain Medicine

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