Les spondyloarthrites à début tardif

Abstract

Spondyloarthritis are usually observed in young adults, however an onset after 45 or even 50 years of age are not exceptional. The distribution of the type of spondyloarthritis differs in older subjects and in particular psoriatic arthritis becomes very preponderant at theses ages. The clinical expression of late-onset spondyloarthritis is as varied as in young patients. The diagnostic difficulty lies in the greater number of differential diagnoses and the difficulty of interpreting sacroiliac and spine imaging at this age. Some misleading presentations are common in late-onset disease, such as LOPS (late onset peripheral spondyloarthritis) consisting of mild inflammatory oligoarthritis that contrasts with general signs, severe inflammatory syndrome, and sometimes asymmetrical edema on the legs. Late-onset spondyloarthritis may presenting as polymyalgia rheumatica-like syndrome, but corticosteroid resistance should attract attention. Advanced age is not, in itself, a sufficient argument to reject a diagnosis of spondyloarthritis. A family history of spondyloarthritis and phenotype HLA B27 often constitute essential indicators pointing towards this diagnosis.