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

Abstract Background: Axial Spondyloarthritis (axSpA) is a chronic inflammatory disease of sacroiliac joints and spine and affects patients in second and third decades of life. However, the incidence of this group of diseases has increased in advanced age. Objectives: The aim of this study is to broaden the current knowledge about late onset axSpA and compare clinical features with early-onset patients. Methods: A total of 123 axSpA patients (42 late-onset axSpA, 81 early-onset axSpA) recruited in the study. Patients with symptoms began after 50 years or older were classified as late-onset axSpA. Patients baseline clinical and radiological findings, HLA B27 status, CRP results were recorded. Disease activity was measured by BASDAI index. To assess frailty in late-onset patients, CSF scale was used. Late-onset axSpA patients were reevaluated for frailty after 6 months of treatment. Results: Female gender was predominant in late-onset axSpA (n:35/42). 57,1%patients were nr-axSpA. Late-onset patients had higher frequency of female gender (p:0,000), peripheral arthritis (p:0,000) and cervical vertebrae involvement (p: 0,002 ) compared with early-onset axSpA patients. NSAIDs response was similar (p:0,572). Median CSF score is 5 at presentation and 3 at month 6 in late-onset axSpA. Patients who received anti-TNF therapy had higher improvement in CSF scores (p:0.003). Conclusion: AxSpA is very common in general population and has an increasing incidence among elderly patients. Delay in the diagnosis and treatment of late-onset patients leads to serious deterioration in daily life activities. Late-onset patients should be included in clinical trials and epidemiological studies.