Systemic lupus erythematosus (SLE), most commonly known as lupus, is an autoimmune illness that affects all parts of the body. Patients with lupus have overactive immune systems that attack their own healthy body tissues. Lupus most often appears when a person is between 15 and 35 years of age – typically with symptoms of arthritis, rash, hair loss, sun sensitivity, and problems with the kidneys and blood. The illness is subtly different when it appears in people of other age groups.
Because, once it begins, SLE remains (it can be controlled but not cured), understanding the effects of lupus on the body over time is essential for people diagnosed with the condition so they can anticipate what to expect as they age. However, lupus is widely diverse: it is difficult to find two patients who experience the disease in the same way. Thus, it’s best to work with your physician to review the specifics of your case to help you better understand the nature of your condition and how it may progress with time.
Children who develop lupus before adolescence often have a genetic abnormality predisposing them to the disease:
- Symptoms – The condition in very young children tends to be somewhat more severe and have more atypical symptoms, such as very enlarged lymph nodes.
- Treatment Effects – An important consideration is the effect of lupus treatments on the body. High doses of corticosteroids, in particular, can stunt growth and change appearance.
- Social and Intellectual Development – Young children with lupus may experience delays in growth in these areas.
Adolescents with lupus generally have the same features of SLE as appear in adults—modified by the fact of being an adolescent:
- Kidney Disease Complications –lupus symptoms are more likely to be severe in teens; teenagers have a higher risk of developing kidney disease than do people later in life.
- Effects of Living with a Chronic Illness – Teens often worry about the effects of having a chronic illness on their social life, body image, emotional well-being, and competitiveness in athletics and in school.
- Alternative Treatments – Teens are also more likely to experiment with alternative treatments and illicit medications than are adults.
Young Adults (ages 18-35):
Patients in this age group face many life choices that can influence how they and their physicians will approach treatment:
- Fertility and Contraception – It’s important to time pregnancies when lupus is relatively quiet. Women should ask their physician which methods of contraception are safe and effective.
- Childbearing – Women with lupus will need to coordinate their care with specialists in maternal fetal medicine to minimize the potential for complications of pregnancy. They also will want to balance the physical demands of childcare with the need to effectively manage their symptoms.
- Career – Sometimes the symptoms of lupus can be debilitating enough to require accommodations at work. These accommodations may include being permitted to work from home or have flexible work hours during periods of lupus fatigue.
- Other life milestones – Being ill complicates marriage, caring for young children or aging parents, and other relationships. Having to deal with these stresses can increase fatigue and reduce your ability to care for yourself.
Lupus that appears in late-adulthood tends to be milder than what younger adults experience and generally does not involve problems with the kidneys. However, the effects of aging on the body generally play a much larger role in determining appropriate therapy. Among the health issues your physician will consider are a history of:
- Breast or prostate cancer
Treatment of seniors also depends in part on social and economic issues, such as healthcare costs, careers and retirement, the availability of caregivers, and the level of disability.
For information on this topic and more, visit the HSS Lupus and APS Center of Excellence page.
Michael D. Lockshin is the director of the Barbara Volcker Center for Women and Rheumatic Disease at HSS. He is the author of nearly 300 research papers, book chapters, and books, most on the topic of lupus, pregnancy, antiphospholipid syndrome and sex differences in disease.