Does Age Matter in Psoriatic Arthritis? A Comprehensive Overview
In a recent narrative review published in The Journal of Rheumatology, Fragoulis et al. explore the complex role of age in Psoriatic Arthritis (PsA) and Psoriatic Disease (PsD), shedding light on how age influences disease characteristics, comorbidities, and treatment outcomes.Understanding Psoriatic Arthritis and Psoriatic Disease
Psoriatic arthritis is a form of inflammatory arthritis affecting about 0.8% of the population and roughly 10-30% of those with psoriasis (PsO). Together, PsA and PsO are referred to as psoriatic disease (PsD), a complex syndrome characterized by joint and skin manifestations, among other systemic symptoms.The Role of Age in Psoriatic Disease
The review highlights three key domains where age significantly impacts PsD:- Impact on Comorbidities:
- Aging is naturally associated with a higher number of comorbidities, a phenomenon known as multimorbidity. PsD patients, however, often develop these comorbidities earlier than the general population.
- Older PsD patients are more likely to experience cardiovascular comorbidities, diabetes, and obesity, but younger PsD patients exhibit a paradoxically higher relative risk for major adverse cardiovascular events (MACEs), such as heart attacks and strokes.
- Mental health conditions like depression and anxiety are also prevalent, but interestingly, they are more common in younger PsD patients compared to older ones, suggesting that the psychological burden may be heavier for those diagnosed earlier in life.
- Effect on Treatment Response and Safety:
- Treatment decisions in PsD are often influenced by patient age due to concerns about polypharmacy, drug interactions, and side effects. The review notes that biologic treatments, like TNF inhibitors and IL-23/17 inhibitors, show comparable efficacy across age groups, although safety profiles may vary slightly depending on age.
- There’s evidence that treatment with TNF inhibitors in older patients may even reduce cardiovascular risk, as they positively impact atherosclerosis markers. However, new treatments like Janus kinase (JAK) inhibitors require further study, especially in older populations, to fully understand age-related risks.
- Differences Between Early- and Late-Onset PsA/PsO:
- Late-onset PsA (defined as onset after age 50) tends to present with more aggressive symptoms, higher comorbidity rates, and worse overall outcomes compared to early-onset cases. Additionally, the review mentions distinct clinical and genetic differences, further supporting the theory that early- and late-onset PsA are separate subsets of the disease.
- Similar distinctions are observed in psoriasis, where early-onset PsO is linked to more severe skin involvement, whereas late-onset PsO tends to exhibit fewer skin manifestations but more comorbidities.