Late-Onset Psoriatic Arthritis: Are There Any Distinct Characteristics? A Retrospective Cohort Data Analysis

As life expectancy increases, psoriatic arthritis (PsA) in older individuals becomes more prevalent. We explored whether late-onset versus earlier-onset PsA patients display different clinical features at diagnosis and/or during the disease course, as well as different treatment approaches and comorbidity profiles. We retrospectively collected data from consecutive PsA patients attending two rheumatology centers (December 2017-December 2022). Late-onset PsA patients (diagnosis-age: >= 60 years) were compared to those diagnosed before 60 years old. Univariate analyses and logistic regression were performed to examine for factors associated with late-onset PsA. For sensitivity analyses, the cohort's mean diagnosis age was used as the cut-off value. Overall, 281 PsA patients were included (mean +/- SD diagnosis-age: 46.0 +/- 13.3 years). Of them, 14.2% (N = 40) had late-onset PsA. At diagnosis, after controlling for confounders, no demographic and clinical differences were identified. During the disease course, the late-onset group exhibited 65% fewer odds of manifesting enthesitis (adjusted Odds-ratio-adOR 0.35; 95% confidence interval 0.13-0.97), but higher frequency of dyslipidemia (adOR 3.01; 1.30-6.95) and of major adverse cardiovascular events (adOR 4.30; 1.42-12.98) compared to earlier-onset PsA group. No differences were found in the treatment approaches. In sensitivity analyses, PsA patients diagnosed after 46 (vs. <= 46) years old had an increased frequency of hypertension (adOR 3.18; 1.70-5.94) and dyslipidemia (adOR 2.17; 1.25-3.74). The present study underpins that late-onset PsA is not uncommon, while the age at PsA onset may affect the longitudinal clinical expression of the disease. Patients with late-onset PsA were less likely to manifest enthesitis but displayed increased cardiovascular risk.

Automated summary

With increasing life expectancy, psoriatic arthritis (PsA) in older individuals becomes more prevalent. We compared the clinical features, treatment approaches, and comorbidity profiles between late-onset and earlier-onset PsA patients. Late-onset PsA patients had lower odds of enthesitis but higher risks of dyslipidemia and major adverse cardiovascular events during the disease course.