Ankylosing spondylitis management: relation between disease activity and patients age

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Ankylosing spondylitis management: relation between disease activity and patients age

The findings presented by American College of Rheumatology Annual Meeting indicate a close resemblance between markers of disease activity and treatment trends of geriatric patients suffering from ankylosing spondylitis (AS) as compared to younger patients with the same condition.

Data was collected by Omar and his colleagues from patients suffering from spondyloarthropathies residing in longitudinal, Toronto based cohort. Geriatric patients (of at least 65 years) and non-geriatric patients (less than 65 years) were included in the study. The data was collected from a tertiary care orthopaedics clinic in Toronto of age-matched geriatric patients without AS and was referred to as control. Omar exclaimed that “it is important to point out that this study did not aim to specifically look at late onset AS. We aimed to develop a profile of patients who have AS and happen to be elderly, whether they developed the condition early or later in their lives”. A comparison was made between both clinical and experimental data between the cohorts, and a total of 890 patients with AS were identified. Among these, 48 patients were grouped as geriatric, and 322 patients were grouped as the non-AS geriatric with knee osteoarthritis (OA). No differences in gender distribution were found when preliminary comparison was done between young and geriatric patients with AS. Although, geriatric patients with AS tended to be older at the time of diagnosis (p<0.001).

There were no differences in clinical activity between the groups, including mean inflammatory markers or Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores. The geriatric and non-geriatric patients with AS were similar in extra-articular manifestations. There were no significant differences between the two groups instead of the use of NSAIDs, disease-modifying anti-rheumatic drugs, corticosteroids and biologics, or in side effects associated with the agents. Only 1% of patients in the geriatric group began their biologic therapy at 65 years of age or after.

Omar explained that "standard precautions regarding age-related pharmacokinetics may not be necessary to avoid using certain immune-modulating agents in geriatric patients with AS. Real-world, registry-based studies are a valuable resource to address some research questions, but we also need more prospective studies and clinical trials that cater to this specific age group”. An increase in mobility {measured by the Bath Ankylosing Spondylitis Metrology Index (BASMI)} and function {measured by the Bath Ankylosing Spondylitis Functional Index (BASFI)} was observed among geriatric patients with AS (BASMI, P <.001; BASFI, p<.04). This indicates that there is greater restricted spinal mobility and more significant impact on function in the geriatric patient with AS. These patients were also found to have a history of physical trauma and/or injury (p=0.03) and have a higher score on the SF-36 Health Survey. The life scores quality was similar between the groups.

A comparison between the geriatric patients with AS and the geriatric patients with OA reveals that there were more men in the group of patients with AS. Greater functional disability scores was determined between patients with no AS and they have a diabetic and smoking history (p=0.04).

It was concluded that geriatric patients with AS have similar treatment and disease activity parameters, but differ in a select few functional components and comorbidities when compared with the younger population. Further research into the geriatric AS population is needed to better define and manage this group’s specific needs.


American College of Rheumatology

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Original title of article:

Age does not affect disease activity, management in ankylosing spondylitis


Omar A, et al.

Exploratory, Ankylosing spondylitis, Disease activity, Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Functional Index (BASFI)
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