Original articleClinical expression, but not disease outcome, may vary according to age at disease onset in psoriatic spondylitis
Introduction
The spondyloarthropathies comprise at least five diseases, all of which can be differentiated on a clinical basis: ankylosing spondylitis (AS), reactive arthritis (ReA), psoriatic arthritis (PsA), arthritis of chronic inflammatory bowel disease (AIBD) and undifferentiated spondyloarthropathy (USpA) [1]. Spondyloarthropathies are generally observed in young patients but can be observed later in life or in persons older than 50 years of age. All the spondyloarthropathy subgroups are represented in the elderly with some features particular to this age group [2]. In the case of PsA, some few reports suggest that it is more severe in the elderly with worse outcomes than in younger patients [3], [4]. Immunological changes associated with aging, such as higher concentrations of IL-1β and IL-6 in the synovial fluid of elderly onset PsA, may explain these differences [3].
The distinction between elderly versus younger onset PsA might be arbitrarily established in the cut off point of 60 years of age, probably as an extrapolation coming from the field of rheumatoid arthritis (RA). However, RA and PsA are different conditions, and most cases of PsA are diagnosed between the third and fourth decade of life [5]. Therefore it is surprising to observe that no report has been published to date comparing the clinical picture of the disease between patients older and younger than this group of age.
In the present study we have compared the clinical profile of a group of patients with psoriatic spondylitis (PsS) with respect to age at disease onset. Given that most spondylitic patients are diagnosed before 40 years of age, we chose this cut off point for the purposes of the present study.
Section snippets
Methods
This retrospective cohort study included 70 patients diagnosed with PsS on the basis of radiological and clinical criteria plus psoriasis, who were recruited from the Spondylitis Clinic at the Rheumatology Department of Asturias University Central Hospital in northern Spain. These patients are followed on a regular basis in accordance with the standard protocol of the spondylitis outpatient clinic. To be included in the category of PsS, apart of psoriasis, the presence of clear radiographic
Results
Of the 70 patients with PsS (mean age 50 ± 12 years), 44 were men and 26 women (male to female ratio: 1.7). Mean duration of psoriasis was 19 ± 9 years, and the duration of spondylitis was 14 ± 7 years. The average age at onset of psoriasis was 28 ± 14 years, and of arthritis 35 ± 12 years. The mean latency period between the onset of psoriasis and the onset of arthritis was 7 ± 7 years. A positive family history of PsA was recorded in 20% of this series. Psoriasis preceded arthritis onset in 74% of the subjects.
Discussion
PsA is classified with the spondyloarthropathies because of the presence of spondylitis in up to 40% of patients, the occurrence of extra-articular features common to the spondyloarthropathy group, and association with HLA-B27 [5]. PsA may be distinguished from the other spondyloarthropathies by the presence of psoriasis, peripheral arthritis, asymmetrical distribution of the spinal involvement, and lower level of pain and limitation of movement in axial skeleton [5]. Most cases of PsA are
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