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The relationship between aging and lupus is a complicated one and can be difficult for people with lupus to navigate.

Systemic Lupus Erythematosus, SLE is a lifetime struggle and ageing adds new complications to the mix. Aging makes the body’s systems more vulnerable to damage and less able to heal from that damage. This can make many of the usual lifestyle changes used to control lupus, including diet, a lot more taxing for people with lupus. The immune system also becomes less effective across the board with age, and this can have unusual effects on the symptoms of lupus

Age can also increase the risk of depression, loneliness, and isolation for people with lupus. As it becomes more and more difficult to ‘get out there’ and do activities with others, mental health can easily deteriorate. Add in the fears that come with aging, and depression and loneliness are common issues for older people with lupus. 

Medications and being proactive about keeping in contact, both on the patient’s end and on their friends and family’s end, becomes increasingly important with age. So, what exactly is happening in the body with age?

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What is Late Onset SLE

When talking about age and SLE, it is important to discuss late-onset SLE. SLE most commonly appears in women of childbearing age (13-50 years of age.) However, 3-18% of SLE occurrs in people older than 50, and it seems to be a completely different form of lupus. Late-onset SLE generally has milder symptoms, including lower rates of lupus nephritis and kidney involvement.

In an analysis of immunogenic markers in 150 patients with SLE, there were no clinical differences between male and female patients, and young and old patients. On the autoimmune antibody level, they are the same. The symptoms, however, manifest differently, with males having more intense symptoms and later diagnosis and older patients having more comorbidities. 

Aside from the later age and different symptom profile, late-onset SLE is affected similarly by ageing to typical SLE.

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Ageing and the Immune System

The process of ageing is, essentially, the parts of the body reaching their limit. Like any other machine, parts wear out with use, but unlike machines, we can’t generally replace those parts. As a result, many biological processes become messier, less efficient, or start to interfere with other processes. Organs become more fragile, from skin to bone, and that causes problems on its own. This can be especially problematic for people with lupus.

The immune system is directly affected by ageing. The immune system loses some of its ability to coordinate itself with cell-to-cell signals, leaving it vulnerable to attack by diseases. It also becomes less able to stop autoimmune cells from being produced.

The age-related changes to the immune system effect how it functions occur at the cellular level. Older people have slightly more types of memory B cells, the B cells that act as the immune system’s reference for pathogens it has experienced before. However, they have fewer numbers of these cells, which already do not react very quickly or efficiently to threats on their own. So, while the body does remember the many pathogens it has encountered, it is less likely to stir these remembered responses into action – and may do so for the wrong reasons. It also becomes harder for the immune system to create a new ‘entry’ into the immune system’s database. They don’t gain immunity as effectively to new diseases.

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Monocytes in older people behave differently than in younger people. Some of these monocytes turn into dendritic cells, the trigger cells of the immune system that produce compounds that turn up the immune response. These are partially active in older individuals and more likely to react to autoantigens – markers from one’s own cells – than those found in younger people. Monocytes also turn into macrophages, which are more sensitive to certain inflammatory signaling molecules in older people. These two factors together mean that the immune system can go out of control much more easily in elderly patients.

Ageing also causes the mechanisms that prevent autoantibodies, the B and T cells that target the body’s own cells, from being formed to become sloppy and inefficient. More of these self-attackers get through the filter.

The actual effect that ageing has on inflammation, and thus the symptoms of lupus, is a bit more complicated. Some people experience an immune system that reacts more than it should, aggressively causing flares. Others can’t get their immune system to fight off a cold properly. 

Overall, the effects of ageing on the disease course of lupus itself are actually fairly even – Despite age being linked to increased vulnerability, an analysis of 489 SLE patients found that, overall, the intensity of lupus symptoms does not increase with age. Comorbidities like cognitive issues, joint weakness, and fatigue do get worse, though, as both age and lupus cause trouble in the body.

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Symptoms of SLE and Ageing

Aging’s natural effects on the immune system can be very similar in some ways to SLE, effectively giving people with lupus a “double dose” of autoimmune activity. Ageing bodies can cause already existing symptoms to become more intense, and previously ignorable symptoms to emerge. Long term SLE can cause complications of SLE to build up, leading to chronic osteoporosis, bone death, heart disease, and other issues.

The neuropsychiatric symptoms of lupus in particular can get exacerbated by age, in particular. This includes brain fog, challenges with eyesight or hearing, anxiety, depression, headaches, and insomnia are also exacerbated. You can read more about them here

SLE causes memory problems and increases the risks of dementia developing at a later date – in fact, people with lupus are 51% more likely to develop dementia. In a study looking at 4886 people with lupus in Israel, 1.65% of people with lupus developed dementia as opposed to 0.51% of the control group. People with lupus and their families should keep an eye out for the symptoms as they age.

People with lupus are also at an increased risk of developing cardiovascular disease and stroke, which can be life threatening. NSAIDs, a common medication for both heart disease and lupus, have risks and side effects, including gastrointestinal bleeding. 

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Dealing with Aging and SLE

Ageing is a loss of equilibrium between the body and the immune system, and between the appropriate inflammatory response and the checks and balances that the immune system has to keep it under control. Everything starts to fall apart and become imbalanced. Taking time for self-care, finding ways to socialize, and using positive affirmations can be valuable tools for maintaining good mental health. 

NSAIDs such as aspirin can become very important medications for older patients, since they both reduce inflammation and can prevent clotting from occurring due to atherosclerosis. 

In terms of diet, Mediterranian-style diets are easy to follow for most people with dietary restrictions, and are associated with long life and good health. The autoimmune protocol diet is also not bad for older people with lupus, as many of the anti-inflammatory foods on the list are recommended for the elderly as well.

The microbiomes of elderly people naturally change with age, and may be linked to the health changes that they also experience. Probiotics are very good for older people with lupus, since it can help keep their microbiomes healthy.

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