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The treatment and disease activity parameters were found to
be quite similar between the geriatric AS patients and young population. Also, the
non-AS geriatric patients comprised mostly of females, diabetes and smokers.
Ankylosing spondylitis is a type of arthritis
leading to pain and inflammation in spine. Ahmed Omar, MD, The University of Toronto said that, “Ankylosing spondylitis
in the geriatric population tends to be underrepresented in the literature.”
Geriatric population is increasing rapidly worldwide so there is a great need
of research into this patient population. The findings presented by American
College of Rheumatology Annual Meeting reveals that there is close resemblance
between markers of disease activity and treatment trends of geriatric patients
suffering with ankylosing spondylitis 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 comprises of
age group of at least 65 years and non-geriatric patients comprises of age
group less than 65 years. For comparison purpose, data was collected from a
tertiary care orthopedics clinic in Toronto of age-matched geriatric patients
without ankylosing spondylitis (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 ASWe 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 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 was found when preliminary comparisons were
done between young and geriatric patients with AS, although geriatric patients
with AS tended to be older at the time of diagnosis (P<
.001). The study includes pre diagnosis of younger than the elder group and
results reflects that there was greater disease awareness among physicians in
recent years. 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 in lieu of 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 older.
Omar explained that,
“Standard precautions regarding age-related pharmacokinetics still apply, but
the results suggest it may not be necessary to avoid using certain immune-modulating
agents in geriatric patients with AS. In general, there may be a tendency to
undertreat elderly patients due to concerns about drug-related side effects,
but more research is required to better understand the way we can, and should,
use these drugs in the elderly, as earlier trials tend to favor younger
populations. Real-world, registry-based studies are a valuable resource that
can help 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 greater 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 =.03) and
have a higher score on the SF-36 Health Survey. The life scores quality was
similar between 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 =.04).
At last it was concluded by researchers as,
“We show 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.” Julia
Ernst, MS, described that, “Further research into the geriatric AS
population is needed to better define and manage this group’s specific needs.''
American College of Rheumatology
Age does not affect disease activity, management in ankylosing spondylitis
Omar A et al.
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