1. Late-Onset Ankylosing Spondylitis R4 김 광 열 / prof. 이 연 아 MGR review

2. Contents ASAS classification criteria Epidemiology of late onset Ankylosing Spondylitis(AS) Clinical characteristics of late-onset AS Late onset AS 본원 DATA Summury

3. Spondyloarthritis (SpA) POLSKIE ARCHIWUM MEDYCYNY WEWNĘTRZNEJ 2010; 120 (11)

4. Axial & peripheral SpA POLSKIE ARCHIWUM MEDYCYNY WEWNĘTRZNEJ 2010; 120 (11)

6. ASAS axial SpA classification criteria POLSKIE ARCHIWUM MEDYCYNY WEWNĘTRZNEJ 2010; 120 (11)

7. ASAS peripheral SpA classification criteria

8. Ankylosing spondylitis (AS)  The major subtype of spondyloarthritis (SpA)  Most typically seen in younger patients  After the age of 45 years is uncommon  initial manifestations may vary according to the different onset-age subsets Epidemiology of late onset AS  Incidence rate after age 55 years: 2.2 /100,000 person-years in a population-based descriptive study in Rochester, USA (Arthritis Rheum 1992;35:1476-82)  Only 6% had the beginning of symptoms after age 40 years in a survey of the German Ankylosing Spondylitis Society (Curr Opin Rheumatol 2000;12:239-47)

9. Inflammatory back pain Number of arthritis Anterior chest wall involvement Aseptic osteitis Inflammatory bowel disease ESR

10. Cervical pain Arthritis Uveitis Cardiac Lateral flexion

12. Comparison of demographic and initial Lab. data Variables AOAS (n=470) LOAS (n=29) p Female, n (%)101(21.5)13(44.8)0.004 Age at onset, (years)25.9±7.152.7±5.3<0.001 Disease duration (years)11.3±6.86.2±4.9<0.001 Initial laboratory data HLA-B27, n(%)388(82.6)20(69.0)0.037 ESR (mm/hr)29.6±23.847.8 ± 29.8<0.001 CRP (mg/dL)2.4±2.82.9±2.4NS TNF-α inhibitor use (ever), n(%)181(38.5)17(58.6)0.032 Time to use TNF-α inhibitor (months) 29.6±17.31.5±1.30.016 * Results are expressed as mean ± SD unless otherwise specified

13. Initial clinical manifestations at disease onset Variables, n(%) AOAS (n=470) LOAS (n=29) p Initial manifestation Sacroiliac joint pain127(27.1)6(17.2)NS Inflammatory back pain262(55.9)16(53.3)NS Cervical pain88(18.8)12(40.0)0.005 Shoulder pain45(9.6)9(30.0)<0.001 Hip pain178(38.0)13(43.3)NS Anterior chest wall pain31(6.6)9(30.0)<0.001 Lower extremity arthritis171(36.5)17(56.7)0.027 Upper extremity arthritis41(8.7)3(10.0)NS Enthesitis47(10.0)6(20.0)NS Extraarticular manifestations Uveitis49(10.4)5(16.7)NS Dactylitis3(0.6)0(0.0)NS Psoriasis4(0.9)1(3.3)NS Inflammatory bowel disease4(0.9)0(0.0)NS *NS: not significant

14. Outcome measures of disease activity, spinal mobility and radiographic data Variables AOAS (n=120) LOAS (n=22) p BASDAI 4.6±2.45.3 ± 2.5 NS BASMI 2.3±1.83.2 ±1.8 0.057 Radiographic data BASRI total (spine+hip) 5.9±2.65.9±1.7 NS BASRI hip 0.7±0.90.4±0.6 NS BASRI spine 5.3±2.15.5±1.6 NS * Results are expressed as mean ± SD unless otherwise specified NS: not significant

15. Summury  Old age (45 세 이상 ) 에서도 Ankylsoing spondylitis 가 발생할 수 있다.  LOAS 는 일반적인 젊은 나이에 발생한 AS 와는 구별되는 임상양상을 보인다  Cervical pain, ant. chest wall pain 을 호소하는 경우가 흔하다.  Peripheral arthritis 동반하는 경우가 많으며 주로 lower limb 을 침범한 다.  염증성 지표가 진단당시 부터 높게 측정되며 severe 한 양상을 보여 anti-TNF inhibitor 를 투여하게 되는 경우가 많다.