Ankylosing spondylitis is a type of arthritis leading to pain and inflammation in spine. Ahmed Omar, MD, The University of Toronto said that, “Ankylosing spondylitis in the geriatric population tends to be underrepresented in the literature.” Geriatric population is increasing rapidly worldwide so there is a great need of research into this patient population. The findings presented by American College of Rheumatology Annual Meeting reveals that there is close resemblance between markers of disease activity and treatment trends of geriatric patients suffering with ankylosing spondylitis as compared to younger patients with the same condition.

Data was collected by Omar and his colleagues from patients suffering from spondyloarthropathies residing in longitudinal, Toronto based cohort. Geriatric patients comprises of age group of at least 65 years and non-geriatric patients comprises of age group less than 65 years. For comparison purpose, data was collected from a tertiary care orthopedics clinic in Toronto of age-matched geriatric patients without ankylosing spondylitis (AS) and was referred to as control. Omar exclaimed that, “It is important to point out that this study did not aim to specifically look at late onset ASWe aimed to develop a profile of patients who have AS and happen to be elderly, whether they developed the condition early or later in their lives.” A comparison was made between both clinical and experimental data between cohorts and a total of 890 patients with AS were identified. Among these,48 patients were grouped as geriatric and 322 patients were grouped as the non-AS geriatric with knee osteoarthritis (OA). No differences in gender distribution was found when preliminary comparisons were done between young and geriatric patients with AS, although geriatric patients with AS tended to be older at the time of diagnosis (P< .001). The study includes pre diagnosis of younger than the elder group and results reflects that there was greater disease awareness among physicians in recent years. There were no differences in clinical activity between the groups, including mean inflammatory markers or Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores.  The geriatric and non-geriatric patients with AS were similar in Extra-articular manifestations. There were no significant differences between the two groups in lieu of use of NSAIDs, disease-modifying anti-rheumatic drugs, corticosteroids and biologics, or in side effects associated with the agents. Only 1% of patients in the geriatric group began their biologic therapy at 65 years of age or older.

Omar explained that, “Standard precautions regarding age-related pharmacokinetics still apply, but the results suggest it may not be necessary to avoid using certain immune-modulating agents in geriatric patients with AS. In general, there may be a tendency to undertreat elderly patients due to concerns about drug-related side effects, but more research is required to better understand the way we can, and should, use these drugs in the elderly, as earlier trials tend to favor younger populations. Real-world, registry-based studies are a valuable resource that can help address some research questions, but we also need more prospective studies and clinical trials that cater to this specific age group.” An increase in mobility {measured by the Bath Ankylosing Spondylitis Metrology Index (BASMI)} and function {measured by the Bath Ankylosing Spondylitis Functional Index (BASFI)} was observed among geriatric patients with AS (BASMI, P <.001; BASFI, P <.04). This indicates that there is greater restricted spinal mobility and greater impact on function in the geriatric patient with AS. These patients were also found to have a history of physical trauma and/or injury (P =.03) and have a higher score on the SF-36 Health Survey. The life scores quality was similar between groups.

A comparison between the geriatric patients with AS and the geriatric patients with OA reveals that there were more men in the group of patients with AS. Greater functional disability scores was determined between patients with no AS and they have a diabetic and smoking history (P =.04).

At last it was concluded by researchers as, “We show that geriatric patients with AS have similar treatment and disease activity parameters, but differ in a select few functional components and comorbidities when compared with the younger population.” Julia Ernst, MS, described that, “Further research into the geriatric AS population is needed to better define and manage this group’s specific needs.''