Age at onset in axial spondyloarthritis around the world: data from the Assessment in SpondyloArthritis international Society Peripheral Involvement in Spondyloarthritis study

Abstract

Objectives Age at onset is useful in identifying chronic back patients at an increased risk of axial spondyloarthritis (axSpA). Yet, the majority of data on which the age at onset <45 years criterion was based originates from Europe. Therefore, it is unknown if this criterion applies in other parts of the world. We aimed to assess age at onset of axSpA and its relationship with HLA-B27 and gender across the world. Methods Analyses were applied to patients from 24 countries across the world with an axSpA diagnosis and known age at onset of axial complaints. Cumulative probability plots were used to display the cumulative distribution of age at onset of axial symptoms. Linear regression models were built to assess the effect of HLA-B27 and gender on age at onset of axial symptoms. Results 92% of 2,579 axSpA patients had an age at onset of axial symptoms <45 years, with only small variations across the geographical regions (Asia [n = 574; 94%], Europe & North America [n = 988; 92%], Latin America [n = 246; 89%], and Middle East & North Africa [n = 771; 91%]). Age at onset of axial symptoms was consistently lower in HLA-B27 positive patients (median 25[19–32] vs 31[22–39]) and male patients (median 25[19–33] vs 28[21–37]), but in multivariable models an additional statistically significant effect of male gender independent of HLA-B27 was only found in Asia. Conclusion Around the world, the large majority of axSpA patients had an age at onset of axial disease <45, with HLA-B27 and male gender associated with earlier disease onset.

Efficacy and safety of bimekizumab in axial spondyloarthritis: results of two parallel phase 3 randomised controlled trials

“…starting in patients' mid-20s, 5 axSpA has a significant and lasting impact on patient lives [6][7][8] and a high disease burden. 3 Many patients with axSpA fail treatment, do not achieve treatment targets or experience residual symptoms, [9][10][11] demonstrating the need for more treatment options with novel modes of action.…”

“… 1–3 The axSpA spectrum encompasses patients with definitive structural damage to the SIJ visible on plain radiographs (radiographic (r-)axSpA, also known as ankylosing spondylitis 4 ), and patients without definite radiographic sacroiliitis (non-radiographic (nr-)axSpA). Typically starting in patients’ mid-20s, 5 axSpA has a significant and lasting impact on patient lives 6–8 and a high disease burden. 3 Many patients with axSpA fail treatment, do not achieve treatment targets or experience residual symptoms, 9–11 demonstrating the need for more treatment options with novel modes of action.…”

Serum leucine-rich alpha-2 glycoprotein levels in rheumatoid arthritis and spondyloarthritis: A promising biomarker

“…In one study, 92% of patients with AS were less than 45 years old at disease onset. 34 The mean age of the PsA subjects in this study was 41 years old. Research by Deike et al, showed that most cases of PsA began at 50-59 years old.…”

Advanced practice physiotherapists in Scottish primary care: Axial Spondyloarthropathy epidemiology, time to diagnosis, and referrals to rheumatology

“…The predominance of AxSpA diagnoses in females within the current study, contrasts previous research describing bias towards perceived prevalence of AxSpA in males among health professionals, although the latter represented the cohort majority (Redeker et al., 2019). Variation in characteristics between males and females diagnosed with AxSpA has been identified in the literature, with the former being associated with earlier onset of disease (Boel et al., 2022). This was consistent in the current cohort where men had an age at symptom onset (39.6 ± 10.3) 3.7 years earlier than women (43.3 ± 10.8 years).…”

“…Abbreviations: AFC, Agenda for Change; APP, Advanced Practice Physiotherapist; EHSC, Edinburgh Health and Social Care Partnership; MSK, Musculoskeletal; WTE, Whole Time Equivelant.960 -HEPBURN T A B L E 2 HEPBURN -961AS(Boel et al, 2022). Whilst details of the care journeys preceding APP consultation were not available, this may potentially represent missed opportunities for earlier AxSpA diagnosis within the current cohort reported in previous studies given the association between positive radiological findings and disease progression -despite the shorter time to diagnosis recorded compared to the UK nationalT A B L E 2 (Continued)present favourable conditions for early detection of AxSpA and reducing diagnostic delay.…”