Late-Onset Psoriatic Arthritis Linked to Increased Risk of Cholesterol Disorders, Cardiovascular Events

Elena Nikiphorou, MD
Credit: King's College London

Data from an analysis of patients presenting to a pair of rheumatology clinics during a 5-year period is providing clinicians with an overview in the differences in demographic characteristics and disease presentation among those with late-onset psoriatic arthritis (PsA) relative to their counterparts with earlier-onset PsA.¹

Results of the analysis, which included data from more than 280 patients with PsA, indicate those with late-onset disease had lower odds of enthesitis, but greater odds of developing dyslipidemia and experiencing major cardiovascular events than their counterparts with earlier-onset PsA.¹

“In our cohort the late-onset PsA was not uncommon, while the age at PsA onset appeared to be another covariate which may affect the longitudinal clinical expression of the disease and thus needs to be considered in routine clinical practice,” wrote investigators.¹ “We found that patients with late-onset PsA had less frequent enthesitis during the disease course, but showed an increased cardiovascular risk compared to patients with earlier-onset PsA.”

As the global population continues to age and the proportion of adults older than 60 years of age continues to grow, clinicians in multiple specialties have begun to express concern over the implications of increased prevalence of chronic illness. In a study published in 2022, a group from Taiwan reported the incidence of psoriatic arthritis significantly increased from 3.57 to 5.22 per 100,000 persons in Taiwan, with further analysis indicating net age effect on the incidence of psoriatic arthritis increased with advancing age (7.7-fold difference).²

In the current study, which was led by Elena Nikiphorou, MD, a senior adjunct lecturer and consultant rheumatologist at University College London, and a team of colleagues from multiple European institutions, investigators sought to explore how disease course and management might differ for patients with PsA based on timing of disease onset. With this in mind, investigators designed their study as a retrospective analysis of data recorded at a pair of outpatient rheumatology clinics in Greece.¹

The main exposure for the investigators’ analyses was age at onset, which was stratified as those diagnosed at 60 years of age or older and those diagnosed prior to turning 60 years old. Investigators pointed out univariate analyses and logistic regression were used to estimate impact of factors associated with late-onset PsA. Investigators also pointed out the cohort’s mean diagnosis age was used as the cut-off value for sensitivity analyses.¹

Overall, investigators identified 281 patients with PsA for inclusion in their analyses. This cohort was 58.0% female and had a mean age of 46.0 (SD, 13.3) years at diagnosis. Of the 281 patients identified for inclusion, 40 had late-onset PsA. Those with late-onset PsA were 52.5% males and had a mean age at diagnosis of 66.7 (SD, 5.3) years. Those with earlier-onset PsA had a mean age of 42.5 (SD, 10.8) years and 40.2% of patients were males.¹

In univariate analysis, results indicated there were no significant differences in gender, family history of psoriasis or spondylarthritis, BMI, or smoking habits between the late- and earlier- onset PsA group. Investigators pointed out those with late-onset PsA presented with similar clinical manifestations as their counterparts with earlier-onset PsA for axial disease, peripheral arthritis, active skin psoriasis lesions, enthesitis, dactylitis, and inflammatory bowel disease.¹

After adjusting for confounders, no demographic and clinical differences were identified between the cohorts at time of diagnosis. However, investigators highlighted those in the late-onset groups had a 65% relative reaction in odds of manifesting enthesitis (Adjusted odds ratio [aOR], 0.35 [95% confidence interval [CI], 0.13-0.97]) as their counterparts in the earlier-onset group during the disease course. Additional analysis suggested those in the late-onset groups also had an increased frequency of dyslipidemia (aOR, 3.01 [95% CI, 1.30-6.95]) and major adverse cardiovascular events (aOR, 4.30 [95% CI, 1.42-12.98]) relative to their counterparts in the earlier-onset group.¹

When assessing treatment approaches, no differences were observed based on age at diagnosis. In sensitivity analyses, investigators found patients diagnosed after 46 years old had an increased frequency of both hypertension (aOR, 3.18 [95% CI, 1.70-5.94]) and dyslipidemia (aOR, 2.17 [95% CI, 1.25-3.74]) compared to their counterparts in the earlier-onset group.¹

“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,” investigators added.¹

References

1. Gialouri CG, Evangelatos G, Iliopoulos A, et al. Late-Onset Psoriatic Arthritis: Are There Any Distinct Characteristics? A Retrospective Cohort Data Analysis. Life (Basel). 2023;13(3):792. Published 2023 Mar 15. doi:10.3390/life13030792
2. Chen YT, Wu CY, Li YL, Chen LY, Chiou HY. Time Trends in Psoriasis and Psoriatic Arthritis Incidence from 2002 to 2016 in Taiwan: An Age-Period-Cohort Analysis. J Clin Med. 2022;11(13):3744. Published 2022 Jun 28. doi:10.3390/jcm11133744