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Peripheral spondyloarthritis symptoms may increase with age of onset
Patients who develop spondyloarthritis later in life are more likely to experience peripheral symptoms of the illness than patients with onset at a younger age, according to recent results.
In the prospective, observational study, researchers evaluated 1,424 patients with spondyloarthritis (SpA) throughout 29 medical centers in Brazil. Their demographic and clinical information was collected to determine the characteristics of patients more likely to develop the illness at an advanced age.
The mean age of onset was 28.56 years. The disease occurred after 40 years of age among 259 patients (18.2%), after 45 years in 151 patients (10.6%), and after 50 years in 81 patients (5.8%). The most common form of illness was ankylosing spondylitis in 66.3% of participants, with other common conditions including psoriatic arthritis (18%), undifferentiated SpA (6.7%) and reactive arthritis (5.5%).
Investigators found that peripheral involvement of the illness increased with age of onset, while axial involvement decreased (P<.001 for all three age cut-offs). Younger patients were significantly more likely to experience symptoms including inflammatory lower-back pain, alternating buttock pain and radiographic sacroiliitis. Patients who developed the illness later in life were more likely to experience peripheral arthritis, dactylitis, nail lesions and psoriasis (P<.001). Females also were significantly more likely to develop SpA at 40 years of age or older (P<.001 for all three age cut-offs), with a higher number of female patients at each successive cut-off. Family history of the illness was also significantly more likely among older patients (P=.021).
“Patients who present disease onset [older than] 40 years have an atypical clinical profile with predominance of peripheral arthritis, female gender, nail and psoriasis involvement as well as dactylitis,” the researchers wrote. “This atypical clinical profile may lead this group of diseases to be underdiagnosed at this age in favor of other inflammatory disorders, so rheumatologists should be alert to these variations in order to succeed in the diagnosis.”