Background/Purpose:

Most ankylosing spondylitis (AS) patients experience their first symptoms prior to age 45. However, symptoms of AS can develop after the age 45 and the initial manifestations may vary according to the different onset-age subsets. This study was performed to investigate whether there are characteristic clinical features and more inflammatory burdens in the late-onset AS patients compared to adult-onset AS.

Methods:

We retrospectively studied the clinical and laboratory features of 499 AS patients. These patients was fulfilled the modified New York criteria for AS and were classified into 2 groups based on their age at symptom onset: adult-onset AS (>16 but < 45 years; AOAS); and late-onset AS (≥45 years; LOAS). The onset of disease was defined by the day of appearance of the first manifestation of AS. In both groups, the following data were compared:(1) epidemiological variables (sex, age at symptom onset, and duration of disease); (2) laboratory results (HLA-B27, ESR and CRP); (3) clinical manifestations, including signs and symptoms at diagnosis and during follow-up, involvement of the cervical spine, shoulder and hip, and extra-articular manifestations; (4) BASDAI and BASMI; (5) radiographic data (BASRI total and BASRI spine); (6) use of anti-TNF-α agent and time to start anti-TNF-α therapy.

Results:

There were 29 patients (5.8%) with LOAS. LOAS group had more female patients (44.8% vs. 21.5%, p=0.004), shorter disease duration (6.2±4.9 vs.11.3±6.8 years, p<0.001) and less HLA-B27 positivity (69.0% vs. 82.6%, p=0.037) than AOAS group. As an initial manifestation, the patients with LOAS more often presented cervical pain (40.0% vs. 18.8%, p=0.005), shoulder pain (30.0% vs. 6.6%, p<0.001), lower extremity arthritis (56.7% vs. 36.5%, p=0.027), and the anterior chest wall pain (30.0 % vs. 6.6%, p<0.001) than AOAS. Clinical symptoms during follow-up and the radiological scores did not differ between the two groups. The most notable findings of the LOAS group were higher initial ESR (47.8±29.8 vs. 29.6±23.8 mm/hr, p< 0.001) and more frequent use of TNF-α inhibitors during the course of the disease (58.6% vs. 38.5%, p< 0.001). Among the all anti-TNF-α users, LOAS patients tended to show higher BASDAI score and higher ESR at the start of the therapy compared to AOAS .

Conclusion:

Our results suggest that LOAS has distinctive presenting symptoms and a higher inflammatory burden. With increased clinical attention to LOAS as a cause of inflammatory arthritis in elderly patients, a timely initiation of disease-specific treatment can be provided.

---

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/late-onset-ankylosing-spondylitis-has-distinctive-presenting-symptoms-and-a-higher-inflammatory-burden/