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Late-Onset Ankylosing Spondylitis and Spondylarthritis

An Update on Clinical Manifestations, Differential Diagnosis and Pharmacological Therapies

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Abstract

Ankylosing spondylitis (AS) and spondylarthritis (SpA) are generally observed in young male patients but can be diagnosed in the elderly. These cases correspond to late-onset or late-diagnosed AS or SpA. The clinical presentation may be either typical axial disease with a more severe illness compared with young-onset disease, or peripheral oligoarthritis of the lower limbs with pitting oedema (late-onset peripheral spondylarthropathy). New criteria for axial SpA including MRI-determined modifications of the sacroiliac joints may help the clinician with diagnosis. The treatment options for late-onset/-diagnosed AS include the same drugs as those taken by patients with young-onset AS, i.e. NSAIDs, sulfasalazine and anti-tumour necrosis factor (TNF)-α agents. Anti-TNFα agents are very effective drugs in young-onset AS and SpA. However, the effectiveness and safety of this drug class has not been specifically evaluated in elderly AS/SpA patients, and caution is therefore required with use of these drugs in elderly patients with co-morbidities and/or polypharmacy. In particular, careful evaluation for the risk of infection and cardiovascular events is recommended before initiating anti-TNFα agents in this age category. However, safety data from elderly patients with rheumatoid arthritis seem reassuring. With the increasing life expectancy and the new diagnostic modalities for axial (and peripheral) SpA, it is likely that the number of patients (diagnosed) with late-onset AS/SpA will increase. Thus, the clinician must be familiar with the clinical characteristics and particularities of this group of inflammatory rheumatic diseases.

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Acknowledgements

No sources of funding were used to assist in the preparation of this article. The author has no conflicts of interest that are directly relevant to the content of this article.

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Authors and Affiliations

  1. Department of Rheumatology, University Hospital Jean Minjoz, Bd Fleming, 25030, Besançon cedex, France

    Éric Toussirot

  2. Équipe d’Accueil 4266, Agents Pathogènes et Inflammation, University of Franche-Comté, Besançon, France

    Éric Toussirot

  3. CIC - Biotherapy 506, University Hospital St-Jacques, Besançon, France

    Éric Toussirot

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Correspondence to Éric Toussirot.

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Toussirot, É. Late-Onset Ankylosing Spondylitis and Spondylarthritis. Drugs Aging 27, 523–531 (2010). https://doi.org/10.2165/11315970-000000000-00000

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