Understanding why lupus often becomes less severe with age may hold promise for its treatment.
Lupus follows an unusual pattern among chronic diseases. Instead of worsening with age, it often becomes less severe. For the first time, researchers have explained why.
Recent research from the University of California–San Francisco (UCSF) has found that as people living with lupus age, certain immune genes become less active.
“If patients make it through those risky decades, they sometimes see a dramatic improvement,” study author Dr. Sarah Patterson, assistant professor of medicine at UCSF, said in a statement. “I see my younger lupus patients in their 20s, 30s, and 40s every few months, monitoring them closely for signs of severe disease, but many of my older patients just once a year to touch base.”
Making It Past the ‘Risky Decades’
Lupus, or systemic lupus erythematosus, is considered a “classic” autoimmune disease because it exhibits key characteristics that cause immune system dysfunction and systemic inflammation. It affects joints, skin, kidneys, lungs, blood vessels, the heart, the brain, and the nervous system. In young patients, it can be particularly aggressive.
“Lupus in younger individuals can lead to more aggressive kidney damage,” Dr. Viktoryia Kazlouskaya, a double board-certified dermatologist and founder and medical director of Dermatology Circle in New York City, who was not involved in the study, told The Epoch Times.
“I’ve seen it firsthand during residency in Brooklyn, New York. … [there were] young patients already on dialysis for kidney support.”
However, unlike many other long-term illnesses, the condition often becomes milder as patients reach their 60s and 70s.
The study, published in Science Translational Medicine in June, analyzed blood samples from 287 lupus patients and 928 healthy controls who ranged in age from 20 to 83 years.
Researchers found that aging reduces the activity of certain genes involved in immune responses, especially genes stimulated by interferons, which are proteins the body produces to fight infections.
Decline in immune activity was linked to fewer inflammatory proteins in the blood.
Inflammation Decreases With Age
As healthy adults age, their bodies’ inflammation levels rise with stronger inflammation gene and protein activity, a process often called “inflammaging.” However, in patients with lupus, the expression of these genes and proteins—abnormally high in mid-life—actually decreased with age.
“But it wasn’t fully reversed,” senior study author Dr. Chaz Langelier, associate professor of medicine at UCSF, said in a statement. “The lupus patients still had a greater level of inflammatory signaling compared to healthy adults in older age.”
The researchers found that the decrease in immune activity was associated with lower levels of interferons in the blood, which is associated with antiviral activity. They also found epigenetic changes related to aging—alterations that affect what genes get activated without changing the DNA sequence itself.
These findings suggest that epigenetic changes may play a role in reducing disease activity over time and support the idea that disrupting interferon signaling could be a promising approach for treating lupus.
“The finding that certain antiviral genes become less active over time could offer valuable insight that may influence how the disease is monitored [or] managed across various age groups,” Dr. Brynna Connor, a diplomat of the American Academy of Anti-Aging and Regenerative Medicine and a health care ambassador at NorthWestPharmacy.com, who was not involved in the study, told The Epoch Times.
However, Connor said that while it is not impossible for the risk of severe lupus flare-ups to decrease with age, some patients may continue to experience reduced disease activity, while others may develop new organ involvement. Additionally, aging can complicate treatment decisions because of other health conditions and the body’s changing ability to tolerate medications such as NSAIDs or corticosteroids.
Broader Research Applications
The researchers plan to explore whether drugs that block interferons are more or less effective in patients at different ages and hope to extend their research to other conditions involving inflammation, such as rheumatoid arthritis, chronic obstructive pulmonary disease, and hardening of the arteries.
“Beyond lupus, the study has broader implications for autoimmune research, as it signals that the immune system doesn’t behave the same throughout life,” Connor said.
An improved understanding of how immune gene expression evolves with age will help doctors to more precisely anticipate disease progression and adjust treatment strategies, according to Connor.
