Extended reports
Clinical and laboratory manifestations of elderly onset psoriatic
arthritis: a comparison with younger onset disease
Division of
Rheumatology, University of Padova, Italy
Correspondence to: Dr L Punzi, Cattedra e Divisione di Reumatologia, Policlinico Università, via Giustiniani 2, 35128 Padova, Italy.
Accepted for publication 25 January 1998
OBJECTIVE
Although
the influence of age on clinical and laboratory features has been
widely demonstrated in many arthropathies, studies on elderly onset (> 60 years) psoriatic arthritis (EOPsA) are rare. This study compares
manifestations at onset and two year outcome of EOPsA with those of
younger onset PsA (YOPsA).
PATIENTS AND
METHODSSixty six consecutive PsA patients with
disease duration < 1 year, 16 EOPsA (>60 years) and 50 YOPsA (
60
years) were admitted to a prospective study. Clinical, laboratory, and
radiographic assessment were carried out at admission and after two
years. HLA class I and bone scintigraphy were also recorded. In 10 patients with EOPsA and 24 with YOPsA it was possible to obtain
synovial fluid, which was subsequently analysed for local inflammatory indices, including interleukin (IL) 1
, IL6, and IL8.
RESULTSPresenting
manifestations of EOPsA differed from YOPsA in number of active joints
(mean (SD)) (12.2 (6.3) v 6.7 (4.6),
p<0.001), foot bone erosions (2.7 (1.2) v
1.1 (1.1), p<0.001), erythrocyte sedimentation rate (64.2 (35.3)
v 30.5 (30.0) mm 1st h, p<0.001), C
reactive protein (3.9 (2.0) v 1.3 (1.3)
mg/dl, p<0.001) and synovial fluid IL1 (8.0 (4.7)
v 3.0 (3.0) pg/ml, p<0.001) and IL6 (828.2 (492.6) v 469.3 (201.4) pg/ml,
p<0.005). No differences were found in the number of subjects with
dactylitis, pitting oedema, HLA-B27, or signs of sacroiliac and
sternoclavicular joint involvement at bone scintigraphy. After two
years, progression was more evident in EOPsA than in YOPsA, as the
number of new erosions in the hands and also the C reactive protein
were higher in EOPsA patients.
CONCLUSIONPsA
has a more severe onset and a more destructive outcome in elderly
people (onset >60 years) than in younger subjects. This behaviour may
be influenced by immune changes associated with aging, as suggested by
the higher concentrations of IL1 and IL6 found in the synovial fluid
of EOPsA than in YOPsA.
© 1999 by Annals of the Rheumatic Diseases
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