Age has been suggested to modify systemic lupus erythematosus expression. In this study we have attempted to study 13 patients with late onset (40 years and above) and 90 with early onset disease (below 40 years) to determine whether age-related differences in disease expression exist and whether the genetic make-up influences the age of disease onset. We found that patients with late onset disease initially presented with pericarditis (31% vs 3%, P<0.005) and a lower incidence of malar rash (31% vs 57%, p<0.05). During the disease course, there was a lower incidence of mucocutaneous symptoms especially malar rash (p<0.005) and psychosis (p<0.05) in the late onset group. Serological parameters were similar in both groups. There was a prevalence of HLA-DQA1*0103 in Chinese patients with late onset disease (pcorr=0.004). These findings suggest that a subgroup of late onset patients may experience milder disease and that the risk conferred by the HLA-DQA1*0103 may be significant among these patients.
We report a Malay man, with underlying chronic medical illnesses, presenting with positive symptoms of schizophrenia, including Capgras syndrome (CS) at the age of 73. Physical examination and blood investigations were normal and brain CT scan showed age-related cerebral atrophy. Neuropsychological assessment showed probable right hemisphere lesions but relatively intact memory and intellectual functions. Several neuroleptics including depot injections were tried but ineffective. Positive symptoms including CS eventually improved with clozapine before his death from myocardial infarction. This case report highlights the uncommon occurrence of CS in treatment resistant schizophrenia (TRS) of very late onset and its treatment challenges.