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Objectives We investigated differences in demographic, clinical, and serological features between early-onset (EoL) and late-onset (LoL) systemic lupus erythematosus (SLE) in a cohort of South African patients.Methods A retrospective study of 240 consecutive SLE patients, including 200 known alive and 40 known deceased patients, matched for age and gender, and seen at the Lupus Clinic, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa.Results Most patients, 203 (84.6%), were EoL, of Black African ancestry, 225 (93.8%), and female, 231 (96.3%). Mean ages were 34.4 and 57.5 years for the EoL and LoL groups, respectively. Anaemia (72.1%), arthritis (67.6%), discoid lupus (50%) and nephritis (43.8%) were overall the commonest clinical features. Significant differences between the groups are shown in the table below.Deaths from infections occurred in 13/35 (37.1%) and 2/5 (40%) of the EoL and LoL groups, respectively (p=0.9).Abstract PO:04:109 Table 1Conclusions Serositis, haematological abnormalities and nephritis, especially proliferative and membranous LN were more prevalent in the EoL group. A higher prevalence of anti-Ro and anti-La positivity was observed in the LoL group, whilst anti-Sm antibodies and hypocomplementaemia were more frequent in the EoL group. Infections were more common in the EoL group but contributed almost equally as causes of death in the two groups.