Analysis by Age Group of Disease Outcomes in Patients with Psoriatic Arthritis: A Cross-Sectional Multicentre Study

  • Rubén QueiroEmail author
  • Estefanía Pardo
  • Lilyan Charca
  • Sara Alonso
  • Luis Arboleya
  • Mercedes Alperi
Original Research Article



Elderly psoriatic arthritis (PsA) patients may show greater inflammatory activity and worse prognoses than patients of other ages. However, these patients may be at risk of receiving fewer systemic treatments. In this report, we have analysed disease outcomes in PsA by age groups.


This cross-sectional, multicentre study included 227 PsA patients under biological and non-biological systemic therapies. The study population was divided into four categories by age: < 40, 40‒49, 50‒65 and > 65 years. Physical functioning, disease activity, remission rates and disease impact were compared.


Thirty-one patients (13.7%) were under 40 years, 26.9% (n = 61) were 40–49 years, 26.4% (n = 60) were 50–65 years and 33.0% (n = 75) were patients > 65 years. Compared with the other age groups, disease duration was significantly higher in subjects older than 65 years (p < 0.001). Only 8% of patients older than 65 years received corticosteroids compared with 29% of patients aged < 40 years, 13.1% of patients aged 40–49 years and 26.7% of patients aged 50–65 years (p = 0.007). Similarly, only 36% of patients over 65 years of age received a biological therapy compared with between 51.6 and 59% for the other age groups (p = 0.036). However, remission rates were not statistically different between groups. Disease-associated physical disability was similar among groups. Compared with patients aged < 40 years, more patients > 65 years achieved low disease impact (10.7% vs 37.7%, respectively; p < 0.05).


Fewer older patients received corticosteroids and biological therapy. However, disease outcomes were similar or even better compared with those observed in younger patients. Therefore, treatment strategies for older patients with PsA should be similar to those offered to younger individuals.



MAAPs (Minimal Activity in Psoriatic Arthritis) Study Group: J.D. Cañete (H. Clinic, Barcelona, Spain); C. Montilla (HU. Salamanca, Salamanca, Spain); M.A. Abad (H. Virgen del Puerto, Plasencia, Spain); S. Gómez (Pfizer Medical Department, Madrid, Spain); M. Montoro (Pfizer Medical Department, Madrid, Spain); A. Cabez (Pfizer Medical Department, Madrid, Spain); J.C. Torre Alonso (H. Monte Naranco, Oviedo, Spain); J.A. Román-Ivorra [Hospital Universitario (HU) La Fe, Valencia, Spain]; J. Sanz (HU Puerta de Hierro, Madrid, Spain); J. Salvatierra (HU San Cecilio, Granada, Spain); J. Calvo-Alén (HU Sierrallana, Torrelavega, Spain); A. Sellas (Vall d’Hebron, Barcelona, Spain); F.J. Rodriguez (Santa Lucia, Cartagena, Spain); A. Bermúdez (Virgen de la Arrixaca, Murcia, Spain); M. Romero (Complejo hospitalario Jaén, Spain); M. Riesco (Rheumatology H. Juan Ramón Jiménez, Huelva, Spain); J.C. Cobeta (H. Royo Villanova, Zaragoza, Spain); F. Medina (H. Puerta del Mar, Cádiz, Spain); A. Aragón (H. Getafe, Madrid, Spain); M.L. García (HU Basurto, Bilbao, Spain); A. Urruticoechea (H. Can Misses, Ibiza, Spain); C.M. González (HU Gregorio Marañón, Madrid, Spain); E. Judez (HU, Albacete, Spain); B. González (HU Nta. Sra de la Candelaria, Tenerife, Spain); P. Fernández (HU 12 de Octubre, Madrid, Spain); L. Pantoja (H. del Bierzo, Leon, Spain); R. Morlá (H. Sant Pau y Sta. Tecla, Tarragona, Spain).

Compliance with Ethical standards


The MAAPS study was funded by Pfizer.

Conflict of interest

RQ, EP, LC, SA, LA and MA declare that they have no conflict of interest.


  1. 1.
    Ritchlin CT, Colbert RA, Gladman DD. Psoriatic arthritis. N Engl J Med. 2017;376:957–70.CrossRefGoogle Scholar
  2. 2.
    Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM. Time trends in epidemiology and characteristics of psoriatic arthritis over 3 decades: a population-based study. J Rheumatol. 2009;36:361–7.CrossRefGoogle Scholar
  3. 3.
    Liew JW, Ramiro S, Gensler LS. Cardiovascular morbidity and mortality in ankylosing spondylitis and psoriatic arthritis. Best Pract Res Clin Rheumatol. 2018;32:369–89.CrossRefGoogle Scholar
  4. 4.
    Henseler T, Christophers E. Psoriasis of early and late onset: characterization of two types of psoriasis vulgaris. J Am Acad Dermatol. 1985;13:450–6.CrossRefGoogle Scholar
  5. 5.
    Olivieri I, Pipitone N, D’ Angelo S, Padula A, Salvarani C. Late-onset rheumatoid arthritis and late-onset spondyloarthritis. Clin Exp Rheumatol. 2009;27(4 Suppl 55):S139–45.PubMedGoogle Scholar
  6. 6.
    Queiro R, Tejon P, Alonso S, Coto P. Age at disease onset: a key factor for understanding psoriatic disease. Rheumatology (Oxford). 2014;53:1178–85.CrossRefGoogle Scholar
  7. 7.
    Caso F, Tasso M, Chimenti MS, Navarini L, Perricone C, Girolimetto N, et al. Late-onset and elderly psoriatic arthritis: clinical aspects and management. Drugs Aging. 2019. Scholar
  8. 8.
    Queiro R, Cañete JD, Montilla C, Abad M, Montoro M, Gómez S, et al. MAAPS study group. Minimal disease activity and impact of disease in psoriatic arthritis: a Spanish cross-sectional multicenter study. Arthritis Res Ther. 2017;19(1):72.CrossRefGoogle Scholar
  9. 9.
    Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, CASPAR Study Group. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006;54:2665–73.CrossRefGoogle Scholar
  10. 10.
    Pincus T, Summey JA, Soraci SA Jr, Wallston KA, Hummon NP. Assessment of patient satisfaction in activities of daily living using a modified Stanford Health Assessment Questionnaire. Arthritis Rheum. 1983;26:1346–53.CrossRefGoogle Scholar
  11. 11.
    Schoels MM, Aletaha D, Alasti F, Smolen JS. Disease activity in psoriatic arthritis (PsA): defining remission and treatment success using the DAPSA score. Ann Rheum Dis. 2016;75:811–8.CrossRefGoogle Scholar
  12. 12.
    Gossec L, de Wit M, Kiltz U, Braun J, Kalyoncu U, Scrivo R, et al. A patient-derived and patient-reported outcome measure for assessing psoriatic arthritis: elaboration and preliminary validation of the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire, a 13-country EULAR initiative. Ann Rheum Dis. 2014;73:1012–9.CrossRefGoogle Scholar
  13. 13.
    Punzi L, Pianon M, Rossini P, Schiavon F, Gambari PF. Clinical and laboratory manifestations of elderly onset psoriatic arthritis: a comparison with younger onset disease. Ann Rheum Dis. 1999;58:226–9.CrossRefGoogle Scholar
  14. 14.
    Kobak S, Yildiz F, Karaarslan A, Semiz H, Orman M. Characteristics of Turkish patients with elderly onset psoriatic arthritis: a retrospective cohort study. Medicine (Baltimore). 2017;96(33):e7833.CrossRefGoogle Scholar
  15. 15.
    Polachek A, Al-Johani R, Li S, Ye JY, Chandran V, Gladman D. Late onset psoriatic arthritis in a longitudinal cohort: disease presentation, activity over time and prognosis. Semin Arthritis Rheum. 2019;48:834–9.CrossRefGoogle Scholar
  16. 16.
    Rea IM, Gibson DS, McGilligan V, McNerlan SE, Alexander HD, Ross OA. Age and age-related diseases: role of inflammation triggers and cytokines. Front Immunol. 2018;9:586.CrossRefGoogle Scholar
  17. 17.
    Patel P, Rosen CF, Chandran V, Ye YJ, Gladman DD. Addressing comorbidities in psoriatic disease. Rheumatol Int. 2018;38:219–27.CrossRefGoogle Scholar
  18. 18.
    Queiro R, Cañete JD. Impact of cardiovascular risk factors on the achievement of therapeutic goals in psoriatic arthritis: is there any association? Clin Rheumatol. 2018;37:661–6.CrossRefGoogle Scholar
  19. 19.
    Costa L, Lubrano E, Ramonda R, Chimenti MS, Vezzù M, Perrotta FM, et al. Elderly psoriatic arthritis patients on TNF-α blockers: results of an Italian multicenter study on minimal disease activity and drug discontinuation rate. Clin Rheumatol. 2017;36:1797–802.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Rheumatology Division, Department of Internal MedicineHospital Universitario Central de AsturiasOviedoSpain

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