Skip to main content

Advertisement

SpringerLink
Log in

Spondyloarthritis with Onset After Age 45

  • SERONEGATIVE ARTHRITIS (MA KHAN, SECTION EDITOR)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

The ASAS (Assessment in SpondyloArtrhritis international Society) classification criteria for axial and peripheral spondyloarthritis permit to classify patients with age at disease onset less than 45 years. Nevertheless, these two forms of spondyloarthritis may begin after the age of 45. With the longer duration of the life expectancy, patients with this late-onset form of spondyloarthritis may be more frequently recognized in the near future. A small percentage (ranging from 3.5 to 6 %) of patients with axial SpA, as defined by the modified New York criteria, have onset of their disease after 45 years of age. Relatively more frequent is the late onset form of peripheral spondyloarthritis with the characteristics of undifferentiated spondyloarthritis. Its clinical spectrum is as broad as it is in children and very young adults. Psoriatic arthritis frequently begins over the age of 45 and occasionally after the age of 60. Some old studies had suggested than elderly-onset psoriatic arthritis is more severe than younger-onset disease, but a recent study found no such difference, and further studies are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •Of importance •• Of major importance

  1. Khan MA. Newer clinical and radiographic manifestations of the seronegative spondyloarthropathies. Curr Opin Rheumatol. 1989;1:139–43.

    Article  PubMed  CAS  Google Scholar 

  2. Khan MA, van der Linden SM. A wider spectrum of spondyloarthropathies. Semin Arthritis Rheum. 1990;20:107–13.

    Article  PubMed  CAS  Google Scholar 

  3. Khan MA, van der Linden SM. Undifferentiated spondyloarthropathies. Spine: State Art Rev. 1990;4:657–64.

    Google Scholar 

  4. Dougados M, van der Linden S, Juhlin R, et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991;34:1218–27.

    Article  PubMed  CAS  Google Scholar 

  5. Amor B, Dougados M, Mijiyawa M. [Critères de classification des spondylarthropathies] [French]. Rev Rhum Mal Osteoartic. 1990;57:85–9.

    PubMed  CAS  Google Scholar 

  6. Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum. 1984;27:361–8.

    Article  PubMed  Google Scholar 

  7. Khan MA, van der Linden SM, Kushner I, et al. Spondylitic disease without radiological evidence of sacroiliitis in relatives of HLA B27 positive patients. Arthritis Rheum. 1985;28:40–3.

    Article  PubMed  CAS  Google Scholar 

  8. Rudwaleit M, van der Heijde D, Landewé R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68:777–83.

    Article  PubMed  CAS  Google Scholar 

  9. Rudwaleit M, van der Heijde D, Landewé R, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2011;70:25–31.

    Article  PubMed  CAS  Google Scholar 

  10. Taylor W, Gladman D, Helliwell P, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006;54:2665–73.

    Article  PubMed  Google Scholar 

  11. Van den Berg R, van Gaalen F, van der Helm-van MA, et al. Performance of classification criteria for peripheral spondyloarthritis and psoriatic arthritis in the Leiden early cohort. Ann Rheum Dis. 2012;71:1366–9.

    Article  PubMed  Google Scholar 

  12. Olivieri I, D’Angelo S, Palazzi C, et al. Late-onset spondyloarthritis: subset that should not be forgotten. J Rheumatol. 2012;39:1110–2.

    Article  PubMed  Google Scholar 

  13. Toussirot E, Wendling D. Late-onset ankylosing spondylitis and related spondyloarthropathies: clinical and radiological characteristics and pharmacological treatment options. Drugs Aging. 2005;22:451–69.

    Article  PubMed  CAS  Google Scholar 

  14. Olivieri I, Pipitone N, D’Angelo S, et al. Late-onset rheumatoid arthritis and late-onset spondyloarthritis. Clin Exp Rheumatol. 2009;27 Suppl 55:S139–45.

    PubMed  CAS  Google Scholar 

  15. • Skare TL, Leite N, Bortoluzzo AB, et al. Effect of age at disease onset in the clinical profile of spondyloarthritis: a study of 1424 Brazilian patients. Clin Exp Rheumatol. 2012;30:351–7. This study identified two different clinical patterns in SpA defined by age at the onset of disease: one with predominant axial symptoms in patients with disease onset <40 years and the other with prevalent peripheral manifestations in those with later disease onset.

    PubMed  CAS  Google Scholar 

  16. Carbone LD, Cooper C, Michet CJ, et al. Ankylosing spondylitis in Rochester, Minnesota, 1935–1989. Is the epidemiology changing? Arthritis Rheum. 1992;35:1476–82.

    Article  PubMed  CAS  Google Scholar 

  17. Feldtkeller E, Bruckel J, Khan MA. Scientific contributions of ankylosing spondylitis patient advocacy groups. Curr Opin Rheumatol. 2000;12:239–47.

    Article  PubMed  CAS  Google Scholar 

  18. •• Chen HA, Chen CH, Liao HT, et al. Clinical, functional, and radiographic differences among juvenile onset, adult-onset, and late-onset ankylosing spondylitis. J Rheumatol. 2012;39:1013–8. This study compared clinical, functional, and radiologic outcomes at different ages of onset in patients suffering from AS. Patients with late-onset AS had distinguishing symptoms and signs.

    Article  PubMed  Google Scholar 

  19. • Montilla C, Del Pino-Montes J, Collantes-Estevez E, et al. Clinical features of late-onset ankylosing spondylitis: comparison with early-onset disease. J Rheumatol. 2012;39:1008–12. In the Spanish Society of Rheumatology database of 1,257 patients with AS, 44 (3.5 %) had disease onset at the age ≥50 years. These patients showed a significant higher frequency on neck involvement and peripheral arthritis.

    Article  PubMed  Google Scholar 

  20. Brophy S, Calin A. Ankylosing spondylitis: interaction between genes, joints, age at onset, and disease expression. J Rheumatol. 2001;28:2283–8.

    PubMed  CAS  Google Scholar 

  21. Calin A, Elswood J, Edmunds L. Late onset ankylosing spondylitis–a distinct disorder? Br J Rheumatol. 1991;30:69–70.

    Article  PubMed  CAS  Google Scholar 

  22. Calin A, Elswood J. The relationship between pelvic, spinal and hip involvement in ankylosing spondylitis ─ One disease process or several? Br J Rheumatol. 1988;27:393–5.

    Article  PubMed  CAS  Google Scholar 

  23. Vander Cruyssen B, Muňoz-Gomariz E, Font P, et al. Hip involvement in ankylosing spondylitis: epidemiology and risk factors associated with hip replacement surgery. Rheumatology. 2010;49:73–81.

    Article  PubMed  Google Scholar 

  24. Dubost JJ, Sauvezie B. Late onset peripheral spondyloarthropathy. J Rheumatol. 1989;16:1214–7.

    PubMed  CAS  Google Scholar 

  25. Dubost JJ, Ristori JM, Zmantar C, Sauvezie B. [Rhumatismes séronégatifs a début tardif: Fréquence et atypies des spondylarthropathies] [French]. Rev Rhum Mal Osteoartic. 1991;58:577–84.

    PubMed  CAS  Google Scholar 

  26. Olivieri I, Oranges GS, Sconosciuto F, et al. Late onset peripheral seronegative spondyloarthropathy: report of two additional cases. J Rheumatol. 1993;20:390–3.

    PubMed  CAS  Google Scholar 

  27. Olivieri I, Padula A, Pierro A, et al. Late onset undifferentiated seronegative spondylarthropathy. J Rheumatol. 1995;22:899–903.

    PubMed  CAS  Google Scholar 

  28. Caplanne D, Tubach F, Le Parc JM. Late onset spondylarthropathy: clinical and biological comparison with early onset patients. Ann Rheum Dis. 1997;56:176–9.

    Article  PubMed  CAS  Google Scholar 

  29. Olivieri I, Salvarani C, Cantini F, et al. Ankylosing spondylitis and undifferentiated spondyloarthropathies: a clinical review and description of a disease subset with older age at onset. Curr Opin Rheumatol. 2001;13:280–4.

    Article  PubMed  CAS  Google Scholar 

  30. Olivieri I, Padula A, Ciancio G, et al. Late onset HLA-B27-positive undifferentiated spondyloarthropathy: a new series of 20 patients. Arthritis Rheum. 2001;44(Suppl):S94.

    Google Scholar 

  31. McCarty DJ, O’Duffy JD, Pearson L, Hunter JB. Remitting seronegative symmetrical synovitis with pitting oedema. RS3PE syndrome. JAMA. 1985;254:2763–7.

    Article  PubMed  CAS  Google Scholar 

  32. Russell EB, Hunter JB, Pearson L, McCarty DJ. Remitting seronegative, symmetrical synovitis with pitting edema ― 13 additional cases. J Rheumatol. 1990;17:633–9.

    PubMed  CAS  Google Scholar 

  33. Olivieri I, Padula A, Favaro L, et al. Dactylitis with pitting edema of the hand in longstanding ankylosing spondylitis. Clin Rheumatol. 1995;14:701–4.

    Article  PubMed  CAS  Google Scholar 

  34. Koeger AC, Karmochkine M, Chaïbi P. RS3PE syndrome associated with advanced ankylosing spondylitis. J Rheumatol. 1995;22:375–6.

    PubMed  CAS  Google Scholar 

  35. Amor B, Bouchet H, Delrieu F. Enquete nationale sur les arthrites réactionelles de la Societe Francaise de Rhumatologie. Revue Rhum. 1983;50:733–43.

    CAS  Google Scholar 

  36. Olivieri I, Salvarani C, Cantini F. Remitting distal extremity swelling with pitting edema: A distinct syndrome or a clinical feature of different inflammatory rheumatic diseases? J Rheumatol. 1997;24:249–52.

    PubMed  CAS  Google Scholar 

  37. Olivieri I, Salvarani C, Cantini F. RS3PE syndrome: an overview. Clin Exp Rheumatol. 2000;18 Suppl 20:53–5.

    Google Scholar 

  38. Salvarani C, Gabriel S, Hunder GG. Distal extremity swelling with pitting edema in polymyalgia rheumatica. Report on nineteen cases. Arthritis Rheum. 1996;39:73–80.

    Article  PubMed  CAS  Google Scholar 

  39. Salvarani C, Cantini F, Macchioni P, et al. Distal musculoskeletal manifestations in polymyalgia rheumatica: A prospective followup study. Arthritis Rheum. 1998;41:1221–6.

    Article  PubMed  CAS  Google Scholar 

  40. Cantini F, Salvarani C, Olivieri I, et al. Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome: A prospective follow up and magnetic resonance imaging study. Ann Rheum Dis. 1999;58:230–6.

    Article  PubMed  CAS  Google Scholar 

  41. Salvarani C, Hunder GG. Musculoskeletal manifestations in a population-based cohort of patients with giant cell arteritis. Arthritis Rheum. 1999;42:1259–66.

    Article  PubMed  CAS  Google Scholar 

  42. González-Gay MA, García-Porrúa C, Salvarani C, et al. Polymyalgia manifestations in different conditions mimicking polymyalgia rheumatica. Clin Exp Rheumatol. 2000;18:755–9.

    PubMed  Google Scholar 

  43. Olivieri I, Garcia-Porrua C, Padula A, et al. Late onset undifferentiated spondyloarthritis presenting with polymyalgia rheumatica features: description of seven cases. Rheumatol Int. 2007;27:927–33.

    Article  PubMed  Google Scholar 

  44. Olivieri I, Brandi G, Padula A, et al. Lack of association with spondyloarthitis and the HLA-B27 in Italian patients with Whipple’s disease. J Rheumatol. 2001;28:1294–7.

    PubMed  CAS  Google Scholar 

  45. Cantini F, Niccoli L, Olivieri I, et al. Remitting distal lower extremity swelling with pitting oedema in acute sarcoidosis. Ann Rheum Dis. 1997;56:565–6.

    Article  PubMed  CAS  Google Scholar 

  46. Ike RW, Blaivas M. Corticosteroid responsive puffy hands and occult vasculitis neuropathy: RS3PE plus? J Rheumatol. 1993;20:205–6.

    PubMed  CAS  Google Scholar 

  47. Schaeverbeke T, Fatout E, Marcé S, et al. Remitting seronegative symmetrical synovitis with pitting oedema: disease or syndrome? Ann Rheum Dis. 1995;54:681–4.

    Article  PubMed  CAS  Google Scholar 

  48. Billey T, Navaux F, Lassoued S. Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) as the first manifestation of periarteritis nodosa. Report of a case. Rev Rheum [Engl ed]. 1995;62:53–4.

    CAS  Google Scholar 

  49. Gumá M, Casado E, Tena X, Olivé A. RS3PE: Six years later. Ann Rheum Dis. 1999;58:722–3.

    Article  PubMed  Google Scholar 

  50. McCarty DJ. In: McCarty DJ, Koopman WJ, editors. Clinical picture of rheumatoid arthritis. Arthritis and Allied Conditions. 12th ed. Malvern: Lea and Febiger; 1993. p. n781–809.

    Google Scholar 

  51. Magy N, Michel F, Auge B, Toussirot E, et al. Amyloid arthropathy revealed by RS3PE syndrome. Joint Bone Spine. 2000;67:475–7.

    PubMed  CAS  Google Scholar 

  52. Pittau E, Passiu G, Mathieu A. Remitting asymmetrical pitting oedema in systemic lupus erythematosus: two cases studied with magnetic resonance imaging. Joint Bone Spine. 2000;67:544–9.

    Article  PubMed  CAS  Google Scholar 

  53. Cantini F, Salvarani C, Olivieri I. Paraneoplastic remitting seronegative symmetrical synovitis with pitting edema. Clin Exp Rheumatol. 1999;17:741–4.

    PubMed  CAS  Google Scholar 

  54. Olivieri I, D’Angelo S, Palazzi C, et al. Diffuse idiopathic skeletal hyperorostosis: a condition that needs to be differentiated from spondyloarthritis. Curr Rheumatol Rep. 2009;11:321–8.

    Article  PubMed  Google Scholar 

  55. Hoff M, Gulati AM, Romundstad PR, et al. Prevalence and incidence rates of psoriatic arthritis in central Norway: data from the Nord-Trondelag Health Study (HUNT). Ann Rheum Dis. 2013. doi:10.1136/annrheumdis-2013-203862 [Epub ahead of print].

    PubMed  Google Scholar 

  56. Wilson FC, Icen M, Crowson CS, et al. Times trend in epidemiology and characteristics of psoriatic arthritis over three decades: a population-based study. J Rheumatol. 2009;36:362–7.

    Google Scholar 

  57. • Eder L, Chandran V, Shen H, et al. Incidence of arthritis in a prospective cohort of psoriatic patients. Arthritis Care Res. 2011;63:619–22. A cohort of 313 patients with psoriasis uncomplicated by arthritis was followed prospectively with the aim of detecting those who develop PsA. The incident cases of PsA were 10 (4 males and 6 female) with a mean age of 50.4 years.

    Article  Google Scholar 

  58. Kaippanen-Seppänen O. Incidence of psoriatic arthritis in Finland. Br J Rheumatol 1996;35:1289–91.

    Google Scholar 

  59. Punzi L, Pianon M, Rossini P, et al. Clinical and laboratory manifestations of elderly onset psoriatic arthritis: a comparison with younger onset disease. Ann Rheum Dis. 1999;58:226–9.

    Article  PubMed  CAS  Google Scholar 

  60. Salvarani C, Cantini F, Olivieri I, et al. Isolated peripheral enthesitis and/or dactylitis: a subset of psoriatic arthritis. J Rheumatol. 1997;24:1106–10.

    PubMed  CAS  Google Scholar 

  61. Cantini F, Salvarani C, Olivieri I, et al. Distal extremity swelling with pitting edema in psoriatic arthritis: a case control study. Clin Exp Rheumatol. 2001;19:291–6.

    PubMed  CAS  Google Scholar 

  62. López-Montilla MD, González J, Martínez FG, et al. Clinical features of late onset psoriatic arthritis. Exp Gerontol. 2002;37:441–3.

    Article  PubMed  Google Scholar 

  63. Kay LJ, Walker DJ. Late onset spondyloarthropathy: comparison with early onset patients. Ann Rheum Dis. 1997;56:572.

    Article  PubMed  CAS  Google Scholar 

  64. Queiro R, Alperi M, Lopez A, et al. Clinical expression, but not disease outcome, may vary according to age at disease onset in psoriatic spondylitis. Joint Bone Spine. 2008;75:544–7.

    Article  PubMed  Google Scholar 

  65. Olivieri I, D’Angelo S, Padula A, Palazzi C. The challenge of early diagnosis in psoriatic arthritis. J Rheumatol. 2008;35:3–5.

    Article  PubMed  Google Scholar 

  66. Olivieri I, D’Angelo S, Palazzi C, Padula A. Treatment strategies for early psoriatic arthritis. Exp Opin Pharmacother. 2009;10:271–82.

    Article  CAS  Google Scholar 

  67. D’Angelo S, Mennillo GA, Cutro MS, et al. Sensitivity of psoriatic arthritis classification criteria in early psoriatic arthritis. J Rheumatol. 2009;36:368–70.

    Article  PubMed  Google Scholar 

  68. D’Angelo S, Gilio M, Palazzi C, et al. Clinical and laboratory features of late-onset psoriatic arthritis in comparison with younger-onset disease: data from an early arthritis cohort. Ann Rheum Dis. 2013;72 Suppl 3:686.

    Google Scholar 

  69. Henseler T, Christopher E. Psoriasis of early and late onset: characterization of two types of psoriasis vulgaris. J Am Acad Dermatol. 1985;13:450–6.

    Article  PubMed  CAS  Google Scholar 

  70. Kwon HH, Kwon IH, Youn JI. Clinical study of psoriasis occurring over the age of 60 years: is elderly-onset psoriasis a distinct subtype? Into J Dermatol. 2012;51:53–8.

    Article  Google Scholar 

  71. Quiroz R, Allery M, Alonso S, et al. Patients with psoriatic arthritis may show differences in their clinical and genetic profiles depending on their age at psoriatic onset. Clin Exp Rheumatol. 2012;40:476–80.

    Google Scholar 

Download references

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Ignazio Olivieri, Salvatore D’Angelo, Angela Padula, Pietro Leccese, and Carlo Palazzi declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy

    Ignazio Olivieri, Salvatore D’Angelo, Angela Padula, Pietro Leccese & Carlo Palazzi

  2. Rheumatology Department of Lucania - Ospedale San Carlo, Contrada Macchia Romana, 85100, Potenza, Italy

    Ignazio Olivieri, Salvatore D’Angelo, Angela Padula & Pietro Leccese

  3. Rheumatology Department of Lucania - Ospedale Madonna delle Grazie, Contrada Cattedra Ambulante, 75100, Matera, Italy

    Carlo Palazzi

Authors
  1. Ignazio Olivieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Salvatore D’Angelo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Angela Padula
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pietro Leccese
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carlo Palazzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ignazio Olivieri.

Additional information

This article is part of the Topical Collection on Seronegative Arthritis

Rights and permissions

Reprints and permissions

About this article

Cite this article

Olivieri, I., D’Angelo, S., Padula, A. et al. Spondyloarthritis with Onset After Age 45. Curr Rheumatol Rep 15, 374 (2013). https://doi.org/10.1007/s11926-013-0374-7

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11926-013-0374-7

Keywords

Search

Navigation