Identifying Clinical Features, Frailty, and Treatment Responses of Late-onset Axial Spondyloarthritis

Abstract

Abstract Objectives: Axial spondyloarthritis (axSpA) is a chronic inflammatory disease of sacroiliac joints and spine affecting patients in their second and third decades of life. With the increase in the elderly population in the world, the incidence of spondyloarthropathies, as well as other rheumatic diseases, is expected to increase in old age. The aim of this study is to expand the current knowledge of late-onset axSpA and compare clinical features with early-onset patients. Methods: A total of 123 axSpA patients (42 late-onset axSpA and 81 early-onset axSpA) were included in the study. Patients with symptoms that began after 50 years of age or older were classified as late-onset axSpA. Patients’ baseline clinical and radiographic findings, human leukocyte antigen B-27 status, and C-reactive protein results were recorded. Disease activity was measured by Bath Ankylosing Spondylitis Disease Activity Index. The Clinical Frailty Scale (CFS) was used to assess frailty in patients with late-onset. Late-onset axSpA patients were reassessed for frailty after 6 months of treatment. Results: Late-onset axSpA was female predominant (n = 35/42). About 57.1% of patients had nonradiograhic axSpA. Late-onset patients had a higher incidence of female gender (P = 0.000), peripheral arthritis (P = 0.000), and cervical vertebrae involvement (P = 0.002) compared with early-onset axSpA patients. The response to nonsteroidal anti-inflammatory drugs was similar (P = 0.572) between groups. The median CFS score was 5 at presentation and 3 at month 6 in late-onset axSpA. Patients who received anti-tumor necrosis factor therapy showed greater improvement in CFS scores (P = 0.003). Conclusion: AxSpA is very common in the general population and can have a significant impact on quality of life, particularly in old age. In elderly patients, frailty improves significantly with appropriate treatment. Clinicians should avoid being late in diagnosis and treatment.