Spondyloarthritis with Onset After Age 45

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

doi:10.1007/s11926-013-0374-7

Cited by 36 publications

(31 citation statements)

References 44 publications

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“…Aktif infeksiyon, kanser ve dev hücreli arterit sıklıkla, kronik inflamatuvar eklem hastalıkları (RA, spondiloartropatiler, kristal depo hastalıkları vb) ise az da olsa PMR bulgularına eşlik eder. [6][7][8] Ayırıcı tanı zordur ve nadirde olsa birlikteliği bildirilmiştir. [9] Hastalar kortikosteroide yanıt verebilir.…”

Section: Discussionunclassified

A case of polymyalgia rheumatica and ankylosing spondylitis coexistence

Aydeniz¹,

Akaltun

Gür³

et al. 2017

Agri

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ÖzetAnkilozan spondilit omurga ve periferal eklemleri tutan inflamatuvar bir hastalıktır. Polimiyaljia romatika başlıca kalça ve omuz kuşağını tutan, ağrı ve sabah tutukluğuna yol açan inflamatuvar durumdur. Polimiyaljia romatika klinik olarak birçok hastalığı taklit edebilir ve ayırıcı tanı dikkatle yapılmalıdır. Spondiloartropatiler de polimyalji semptomları verebilir ancak nadir de olsa bu iki hastalık birlikte görülebilir. Elli dört yaşında erkek hasta ankilozan Spondilit nedeniyle takip ve tedavideyken, son iki aydır kalça ve omuz kuşağında ağrılarda belirgin artma, hareket kısıtlılığı, sabah tutukluğu nedeniyle kliniğimize başvurdu. Olgunun fizik incelemesinde ağrının kalça ve omuz kuşağında belirgin olması, eritrosit sedimentasyon hızındaki artış ankilozan spondilit ve polimiyaljia romatika birlikteliğini düşündürdü. Olgunun tedavisine kortikosteroid ekleyerek dramatik yanıt iyileşme sağlanması tanıyı destekledi. Hastanın ağrı ve hareket aralığında belirgin düzelme olması ile izleme alındı. Olgumuz eşliğinde, ileri yaşlarda ankilozan spondilit kliniğine polimyaljik bulguların eklenebileceğini ve nadir de olsa bu iki hastalığın birlikte gidebileceğini belirttik. Literatür taramamızda iki hastalığın birlikte görüldüğüaz sayıda yayın olması dikkate değer gördük. Her iki hastalığın birlikte tanı ve uygun tedavisi ile yaşam kalitesinde artma ve iyileşmenin sağlanacağı kanısındayız.Anahtar sözcükler: Ankilozan spondilit; polimiyaljia romatika; rehabilitasyon. SummaryAnkylosing spondylitis is a chronic inflammatory disease that affects the spine and peripheral joints. Polymyalgia rheumatica is an inflammatory disease characterized by aching and prolonged morning stiffness mainly in the shoulder and pelvic girdles. Many other diseases may mimic polymyalgia rheumatica, and thus differential diagnosis is predominantly required. A wide variety of diseases, including spondyloarthropathies, may present polymyalgia-like symptoms, and two diseases rarely coexist. We present a case of a 54-year-old man who had been followed-up for ankylosing spondylitis and presented with pain in the shoulder and pelvic girdles, restricted movement, and morning stiffness for 2 months. Physical examination revealed that the pain was located mostly in the shoulder and pelvic girdles. In addition, increased erythrocyte sedimentation rate revealed the coexistence of the two diseases. Corticosteroid treatment dramatically improved the patient's symptoms and supported the diagnosis. This case demonstrated that ankylosing spondylitis may present polymyalgia-like symptoms, and the two diseases may rarely coexist in the elderly. The coexistence of these two diseases has been rarely reported in literature. Accurate diagnosis of the two diseases is essential for improving the patient's symptoms and quality of life.

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Section: Discussionunclassified

A case of polymyalgia rheumatica and ankylosing spondylitis coexistence

Aydeniz¹,

Akaltun

Gür³

et al. 2017

Agri

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“…34 Late-onset USpA has the same wide spectrum of manifestations as in early onset USpA including enthesitis, dactylitis, and uveitis in various combinations. 28 It can mimic PMR, RS3PE (Remitting Seronegative Symmetric Synovitis with Pitting Edema), and even reflex sympathetic dystrophy at onset. 28,[35][36][37] Late-onset PsA presents more commonly with peripheral manifestations than axial.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…28 It can mimic PMR, RS3PE (Remitting Seronegative Symmetric Synovitis with Pitting Edema), and even reflex sympathetic dystrophy at onset. 28,[35][36][37] Late-onset PsA presents more commonly with peripheral manifestations than axial. Unilateral sacroiliitis and silent axial involvement is more common than bilateral sacroiliitis, while isolated axial disease is less compared to early onset PsA.…”

Section: Clinical Featuresmentioning

confidence: 99%

Rheumatic disease in elderly population, how different from the conventional presentations?

Dhaon¹,

Tripathy²

2016

IJRCI

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“…AS and SpA are usually observed in young patients and a clinical onset after 50 years is uncommon [3]. As we are in the context of an aging population and a longer life expectancy, one may believe that the prevalence of patients with late-onset AS or SpA will rise.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Management of Late-Onset Spondyloarthritis: Implications of Treat-to-Target Recommendations

Toussirot

2015

Drugs Aging

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Spondyloarthritis (SpA) is usually observed in young patients while onset in the elderly is less common. Late-onset forms of SpA may become more common due to longer life expectancy. The clinical spectrum of late-onset SpA is as broad as in young people, with a predominance of peripheral SpA over pure axial disease. The Assessment of SpondyloArthritis international Society (ASAS) has developed new criteria for axial or peripheral SpA that allow patients aged under 45 years at the time of disease onset to be identified. These criteria are not theoretically adapted for the classification of patients with late-onset disease but they are useful for the diagnosis. Similarly, magnetic resonance imaging (MRI) is now widely used for the early recognition of sacroiliitis or spinal inflammation in SpA, and sacroiliitis as evidenced by MRI is included in the ASAS criteria for axial SpA. Nevertheless, the utility of sacroiliac joint and/or spine inflammation as detected by MRI has mostly been described in young patients with ankylosing spondylitis, SpA, or inflammatory back pain, but not in the elderly. The management of SpA is now more focused on remission or, alternatively, low disease activity, according to the treat-to-target recommendations. Such an optimized approach to therapy is thought to improve patient outcomes and ultimately long-term quality of life. The same principles of treatment should apply in the elderly, but require certain adjustments, especially with biological agents. Tumor necrosis factor-α blocking agents are very effective in SpA, but seem slightly less effective in the elderly and are associated with an increased risk of infection in this population. A careful and rigorous evaluation is thus required before initiating these agents in elderly subjects.

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Spondyloarthritis with Onset After Age 45

Cited by 36 publications

References 44 publications

A case of polymyalgia rheumatica and ankylosing spondylitis coexistence

A case of polymyalgia rheumatica and ankylosing spondylitis coexistence

Rheumatic disease in elderly population, how different from the conventional presentations?

Diagnosis and Management of Late-Onset Spondyloarthritis: Implications of Treat-to-Target Recommendations

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