PO:05:071 | Impact of age at onset on Spondyloarthritis clinical profile and quality of life: a monocentric cohort analysis

Federico Fattorini¹, Marco Di Battista¹, Lorenzo Esti¹, Cosimo Cigolini², Andrea Delle Sedie², Marta Mosca^1|2, Linda Carli¹ | ¹Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; ²Rheumatology Unit, AOUP, Pisa, Italy

Background. Spondyloarthritis (SpA) usually affects patients before the fourth decade of life, but later-onset of disease has also been reported (1). Objective To evaluate how the age at onset could influence the clinical profile of SpA and its impact on quality of life.

Methods. Adult patients with a diagnosis of Psoriatic Arthritis (PsA) and Axial Spondyloarthritis (AxSpA), regularly followed at the SpA clinic of our Unit, were consecutively enrolled from November 2023 to April 2024. Their clinical data were collected, as well as patient reported outcome (PROs) [Health Assessment Questionnaire (HAQ), FACIT-Fatigue (FACIT-F), SHORT-FORM 36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Work Productivity and Activity Impairment questionnaire (WPAI)]. We compared different patients’ group according to age at onset: early (<40 years) [group 1], intermediate (>40 and < 60 years) [group 2] and late onset (>60 years) [group 3] at a cross-sectional level. A statistical analysis was performed using logistic regressions and p values <0.05 were considered significant.

Results. We enrolled 281 patients, 156 (55.5%) males (mean age of 58.3±13.8 years); 196 (69.7%) had a diagnosis of PsA while 85 (30.3%) of axSpA. An early onset of the disease was present in 122 (43.4%) patients, while intermediate and late were in 130 (46.3%) and 29 (10.3%) of them respectively. Comparing the groups on the basis of the age at disease onset, those patients with a later onset presented statistical association with swollen joints at the onset (more prevalent in group 3; p< 0.01 vs groups 1 and 2), while axial involvement was more common in group 1 (p=0.02 vs group 2 and 3). PROMs presented similar results in all the age groups except for PGA (Group 3 has significantly worse PGA values, p=0.04, group 3 vs 1) and for WPAI work activity limitation (p=0.03, specifically between group 1 and 2). Figure 1 shows differences between PGA in the 3 groups.

Conclusions. The age of disease onset could influence SpA phenotype; in particular, an early onset is associated with a predominance of axial symptoms, while in the later onset the peripheral manifestations seem prevalent. No significant differences emerged in quality of life, except for the PGA value, which was significantly worse in late-onset forms. Interestingly, patients with an early onset showed a higher compromission in work producitivity. These results could help in phenotyping SpA patients and highlight the opportunity to not underestimate the senile-onset forms of SpA that can be associated with a worsening in patients QoL; moreover, our data underline how young patients, in the prime of their working life, could suffer from the disease burden. References (1): Olivieri I, D'Angelo S, Padula A, et al, Spondyloarthritis with onset after age 45. Curr Rheumatol Rep. 2013 Dec;15(12):374