Clinical Features of Late-onset Ankylosing Spondylitis: Comparison with Early-onset Disease

Objective.Ankylosing spondylitis (AS) is generally observed in young patients but can occur later in life or in persons ≥ 50 years of age. Our objective was to characterize the clinical features of late-onset AS in a large multicenter national cohort.Methods.We studied late-onset AS in the National Registry of Spondyloarthritis of the Spanish Society of Rheumatology (REGISPONSER database) cohort (n = 1257), of whom 3.5% had onset at age ≥ 50 years versus a control group with onset at < 50 years.Results.There were no differences between late-onset and early-onset AS according to sex and family history of spondyloarthropathies. Patients in the late-onset group more often showed involvement of the cervical spine (22.7% vs 9.7%; p = 0.03) and arthritis of the upper (13.6% vs 3.0%; p = 0.002) and lower limbs (27.3% vs 15.2%; p = 0.03) as first manifestations than did patients in the early-onset group. A higher percentage of mixed forms (axial and peripheral joint disease) during the course of the disease was also recorded in the late-onset group (50% vs 24%; p = 0.0001).Conclusion.Our study suggests that age at onset of AS affects the patients’ presenting clinical form. Arthritis of the upper limbs requires a differential diagnosis with other conditions frequent in patients over 50 years of age, such as rheumatoid arthritis or crystal-induced arthropathy.

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The Evolution of Dementia in Idiopathic Parkinson's Disease: Neuropsychological and Clinical Evidence in Support of Subtypes

International Psychogeriatrics ◽

10.1017/s1041610292001248 ◽

1992 ◽

Vol 4 (4) ◽

pp. 147-160 ◽

Cited By ~ 13

Author(s):

Wayne G. J. Reid

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Early Onset ◽

Late Onset ◽

Age At Onset ◽

Critical Determinant ◽

Drug Study ◽

Baseline Phase ◽

Onset Group ◽

Early Onset Group

One hundred and seven newly diagnosed, untreated patients with Parkinson's disease (PD) were divided into two groups according to their age at reported onset of symptoms. Of these, 79 patients were under age 70 (early-onset) and 28 patients were age 70 and over (late-onset). The group of 50 control subjects comprised spouses, friends of the PD patients, and community volunteers. The patients were participants in a multicenter drug study of Parkinson's disease. Each had received a detailed neurological and neuropsychological assessment in the baseline placebo phases of the study. Thirty-4 patients with early-onset and 12 patients with late-onset were reassessed 3 years after treatment with low-dose levodopa, with bromocriptine, or with a combination of the two drugs. The results of the baseline phase of the study revealed that 8% of the early-onset group and 32% of the late-onset group were classified as demented. The 3-year follow-up revealed that the prevalence of dementia had increased to 17% in the early-onset group and to 83% in the late-onset group. This study confirms that at least two distinct subtypes of Parkinson's disease exist. The subtypes differ both clinically and neuropsychologically. The age at onset of symptoms is a critical determinant of the rate and type of cognitive decline in Parkinson's disease.

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Clinical and therapeutic features of myasthenia gravis in adults based on age at onset

Neurology ◽

10.1212/wnl.0000000000008903 ◽

2020 ◽

Vol 94 (11) ◽

pp. e1171-e1180 ◽

Cited By ~ 8

Author(s):

Elena Cortés-Vicente ◽

Rodrigo Álvarez-Velasco ◽

Sonia Segovia ◽

Carmen Paradas ◽

Carlos Casasnovas ◽

...

Keyword(s):

Myasthenia Gravis ◽

Early Onset ◽

Late Onset ◽

Age At Onset ◽

Neuromuscular Diseases ◽

Cross Sectional ◽

Life Threatening ◽

Onset Group ◽

Anti Acetylcholine

ObjectiveTo describe the characteristics of patients with very-late-onset myasthenia gravis (MG).MethodsThis observational cross-sectional multicenter study was based on information in the neurologist-driven Spanish Registry of Neuromuscular Diseases (NMD-ES). All patients were >18 years of age at onset of MG and onset occurred between 2000 and 2016 in all cases. Patients were classified into 3 age subgroups: early-onset MG (age at onset <50 years), late-onset MG (onset ≥50 and <65 years), and very-late-onset MG (onset ≥65 years). Demographic, immunologic, clinical, and therapeutic data were reviewed.ResultsA total of 939 patients from 15 hospitals were included: 288 (30.7%) had early-onset MG, 227 (24.2%) late-onset MG, and 424 (45.2%) very-late-onset MG. The mean follow-up was 9.1 years (SD 4.3). Patients with late onset and very late onset were more frequently men (p < 0.0001). Compared to the early-onset and late-onset groups, in the very-late-onset group, the presence of anti–acetylcholine receptor (anti-AChR) antibodies (p < 0.0001) was higher and fewer patients had thymoma (p < 0.0001). Late-onset MG and very-late-onset MG groups more frequently had ocular MG, both at onset (<0.0001) and at maximal worsening (p = 0.001). Although the very-late-onset group presented more life-threatening events (Myasthenia Gravis Foundation of America IVB and V) at onset (p = 0.002), they required fewer drugs (p < 0.0001) and were less frequently drug-refractory (p < 0.0001).ConclusionsPatients with MG are primarily ≥65 years of age with anti-AChR antibodies and no thymoma. Although patients with very-late-onset MG may present life-threatening events at onset, they achieve a good outcome with fewer immunosuppressants when diagnosed and treated properly.

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Nonataxia symptoms in Friedreich Ataxia

Neurology ◽

10.1212/wnl.0000000000006121 ◽

2018 ◽

Vol 91 (10) ◽

pp. e917-e930 ◽

Cited By ~ 17

Author(s):

Kathrin Reetz ◽

Imis Dogan ◽

Christian Hohenfeld ◽

Claire Didszun ◽

Paola Giunti ◽

...

Keyword(s):

Logistic Regression ◽

Clinical Features ◽

Late Onset ◽

Age At Onset ◽

Friedreich Ataxia ◽

Systematic Evaluation ◽

Multisystem Disorder ◽

Logistic Regression Models ◽

Neonatal Problems ◽

Onset Group

ObjectiveTo provide a systematic evaluation of the broad clinical variability in Friedreich ataxia (FRDA), a multisystem disorder presenting mainly with afferent ataxia but also a complex phenotype of nonataxia symptoms.MethodsFrom the large database of the European Friedreich’s Ataxia Consortium for Translational Studies, 650 patients with genetically confirmed FRDA were included. Detailed data of medical history documentation, questionnaires, and reports on clinical features were analyzed to provide in-depth description of the clinical profile and frequency rates of phenotypical features with a focus on differences between typical-onset and late-onset FRDA. Logistic regression modeling was used to identify predictors for the presence of the most common clinical features.ResultsThe most frequent clinical features beyond afferent ataxia were abnormal eye movements (90.5%), scoliosis (73.5%), deformities of the feet (58.8%), urinary dysfunction (42.8%), cardiomyopathy and cardiac hypertrophy (40.3%), followed by decreased visual acuity (36.8%); less frequent features were, among others, depression (14.1%) and diabetes (7.1%). Most of these features were more common in the typical-onset group compared to the late-onset group. Logistic regression models for the presence of these symptoms demonstrated the predictive value of GAA repeat length on the shorter allele and age at onset, but also severity of ataxia signs, sex, and presence of neonatal problems.ConclusionsThis joint European effort demonstrates the multisystem nature of this neurodegenerative disease encompassing most the central nervous, neuromuscular, cardiologic, and sensory systems. A distinct and deeper knowledge of this rare and chronic disease is highly relevant for clinical practice and designs of clinical trials.

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Clinical characteristics of patients under 40 years old with early-onset hyperuricaemia: a retrospective monocentric study in China

BMJ Open ◽

10.1136/bmjopen-2018-025528 ◽

2019 ◽

Vol 9 (8) ◽

pp. e025528

Author(s):

Yi Zhang ◽

Yong Yang ◽

Leixi Xue ◽

Jian Wen ◽

Lin Bo ◽

...

Keyword(s):

Fatty Liver ◽

Early Onset ◽

Clinical Characteristics ◽

Liver Enzymes ◽

Late Onset ◽

Density Lipoprotein ◽

Control Group ◽

And Control ◽

Onset Group ◽

Early Onset Group

ObjectiveTo investigate the clinical characteristics of patients with early-onset hyperuricaemia (HUC).MethodsA retrospective study using data from the Second Affiliated Hospital of Soochow University was conducted. 623 patients with HUC were divided into early-onset group and late-onset group. Another 201 healthy subjects ≤40 years old were regarded as control group. The data of physical measurements and biochemistry test were collected. Clinical data of early-onset group were compared with late-onset group and control group by analysis of variance (ANOVA) and χ2test. Principal component analysis (PCA) was applied. Logistic regression was used to identify the clinical factors correlated with patients with early-onset HUC.ResultsThe patients of early-onset group had different body mass index (BMI), serum albumin, alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AKP), gamma-glutamyltransferase (GGT), creatinine (Cr), triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL), TG/high density lipoprotein (HDL) ratio, HDL and percentage of males, hypertension (HBP) as well as fatty liver compared with healthy people in the control group. Early-onset group patients had different albumin, ALT, fasting blood glucose, Cr, percentage of males and HBP compared with late-onset group patients. PCA identified four significant patterns including PC1 (labelled ‘TG and HDL’), PC2 (labelled ‘fatty liver and liver enzymes’), PC3 (labelled ‘TC and LDL’) and PC4 (labelled ‘AKP’). The results of univariate and multivariate logistic regression analysis showed that BMI, HBP and albumin were correlative factors for early onset of HUC when the patients with early-onset and late-onset HUC were involved, while gender, BMI, PC1, PC2 and PC4 were correlative factors for early-onset HUC when the early-onset and control groups were involved.ConclusionThis study described a group of patients with early-onset HUC with distinct clinical features. Gender, BMI, ‘TG and HDL’, ‘fatty liver and liver enzymes’ and ‘AKP’ have higher values than HBP, type 2 diabetes mellitus and ‘TC and LDL’ in patients under 40 years old with early-onset HUC.

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Ethnicity and Age at Onset in Bipolar Spectrum Disorders

CNS Spectrums ◽

10.1017/s1092852912000296 ◽

2011 ◽

Vol 16 (6) ◽

pp. 127-134 ◽

Cited By ~ 15

Author(s):

Naima Javaid ◽

James L. Kennedy ◽

Vincenzo De Luca

Keyword(s):

Substance Abuse ◽

Clinical Features ◽

Early Onset ◽

Late Onset ◽

Age At Onset ◽

Admixture Analysis ◽

Bipolar Spectrum ◽

Clinical Marker ◽

Bipolar Spectrum Disorders ◽

Spectrum Disorders

AbstractIntroductionTo determine the influence of ethnicity on the age at onset (AAO) and further understand the significance of AAO as a clinical marker of bipolar and schizoaffective disorders.MethodsAdmixture analysis was used to identify sub-groups characterized by differences in AAO. Differences in clinical features were analyzed for these sub-groups using multivariate logistic regression. Comparisons were made with previous studies using the 2-Sample Kolmogorov-Smirnov Test.ResultsAdmixture analysis yielded a combination of 2 normal theoretical distributions with means (SD) of 16.9 (3.6) for the early-onset sub-group and 24.4 (9.2) years for the late-onset sub-group. The sub-groups were divided by a cut-off of 22 years. There were significant differences between the early and late onset bipolar patient populations regarding substance abuse comorbidity (P=.044) and psychotic features (P=.015). Ethnicity did not have a significant influence on the AAO.DiscussionThe associations between early-onset and higher incidence of psychosis and substance abuse in our sample are consistent with other studies exploring the AAO in bipolar disorder.ConclusionOur findings support the notion of AAO as a clinical marker for the underlying heterogeneity of bipolar spectrum disorders. In particular, we found a strong overlap of early AAO with clinical features associated with greater severity and poor outcome.

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Clinical Features and Prognosis of Late-onset Systemic Lupus Erythematosus: Results from the 1000 Faces of Lupus Study

The Journal of Rheumatology ◽

10.3899/jrheum.080957 ◽

2009 ◽

Vol 37 (1) ◽

pp. 38-44 ◽

Cited By ~ 64

Author(s):

SHELIZA LALANI ◽

JANET POPE ◽

FAYE de LEON ◽

CHRISTINE PESCHKEN

Keyword(s):

Systemic Lupus Erythematosus ◽

Disease Activity ◽

Clinical Features ◽

Lupus Erythematosus ◽

Late Onset ◽

Control Group ◽

Systemic Lupus ◽

Damage Accrual ◽

Onset Group ◽

Onset Systemic Lupus Erythematosus

Objective.There is controversy whether older-onset systemic lupus erythematosus (SLE) is associated with a different, more benign disease course than in younger-onset SLE. Our objective was to characterize the clinical features and prognosis of late-onset SLE in a large, multicenter cohort.Methods.We studied adult-onset lupus in the 1000 Canadian Faces of Lupus cohort (n = 1528) of whom 10.5% had onset at age ≥ 50 years versus a control group with onset at < 50 years.Results.Disease duration was different in early- and late-onset groups (15 yrs in early vs 9.3 yrs in late; p < 0.001). Caucasians were represented more in the later-onset SLE group (55.6% vs 74.5%), while Asians and Blacks were more prevalent in the younger group. Younger-onset SLE subjects fulfilled more American College of Rheumatology criteria for SLE (< 50 yrs: 5.98 ± 1.68; ≥ 50 yrs: 5.24 ± 1.44; p < 0.0001). Despite an equal prevalence of anti-dsDNA, the younger-onset group more often had positive anti-Smith autoantibody, ribonucleoprotein, and hypocomplementemia, and more nephritis, rash, and cytopenias than the older-onset group. However, disease activity and damage accrual were higher in the older-onset group. The older patients received less prednisone and immunosuppressives (current and ever-use). As expected, comorbidity was higher in the older-onset SLE group.Conclusion.This study suggests that older age-onset SLE is not benign. There may be an interaction between lupus and age in which, although there is less lupus nephritis in the elderly, more disease activity and damage are present.

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Hemodynamic Profile and Cardiac Morphometry in Normotension and Severe Preeclamptic Pregnant Women

Indonesian Journal of Obstetrics and Gynecology ◽

10.32771/inajog.v7i1.826 ◽

2019 ◽

pp. 27

Author(s):

Noroyono Wibowo ◽

Peby M Lestari

Keyword(s):

Pregnant Women ◽

Early Onset ◽

Late Onset ◽

Left Ventricular ◽

Severe Preeclampsia ◽

The Other ◽

Control Group ◽

Hemodynamic Profile ◽

Onset Group ◽

Early Onset Group

Abstract Objective: To identify the differences of hemodynamic profile and morphometric changes of maternal heart in normotensive and severe preeclampsia (early-onset and late-onset) pregnant women. Method: Cross-sectional study on consecutively selected 34 pregnant women which divided into three groups: normotensive group (n = 12), early-onset group (n = 11), and the late-onset group (n = 11). Conducted in the ER and inpatient care unit of Obstetrics and Gynecology Department, Faculty of Medicine Sriwijaya University / Dr. Moh. Hoesin Hospital Palembang, from April 2015 - June 2015. Results: There are significant differences in CO and SVR among three groups. In early onset groups, CO values are lower (3.4 + 0:27, p <0.001) with higher SVR (3100.2 + 261.3, p <0.001) compared the other two groups. There is increased of SVR in preeclamptic group compared to control, where SVR is higher in the early onset compared to late-onset group (3100.2 + 261.3 vs 2217.1 + 407.8, p <0.001), as well as differences between groups in cardiac index variables, except in the early onset group and controls (p = 0.045). In blood pressure and MAP variable, we only notice difference between the early onset group and control (p <0.001) as well as late-onset group and controls (p <0.001). There are significant differences in LVMi, LVID and LVPWT among three groups, in which the control group was lower than the other two groups (p <0.001; p = 0.049; p = 0.009), but similar in early and late-onset groups (98.7 (86.5-203) vs 132 (77.7-17.6); 4.7 (0.4) vs 4.8 (0.5); 1.1 (0.7-1.3) vs. 1.1 (0.8-1.6)). While RWT relatively similar among the three study groups (p = 0.264). A post hoc analysis showed no differences in maternal heart morphometry in early onset and late-onset group (p> 0.05). Conclusions: In severe preeclampsia there are changes in hemodynamic, ventricular morphometry, and left ventricular function. But the changes that occurred seems to be more evident in the early onset preeclampsia group of compared than late-onset preeclampsia. Keywords: Normotensive, early onset PEB, PEB late-onset, hemodynamic profile, cardiac morphometry.

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Age at Onset and Clinical Course of Body Dysmorphic Disorder

10.1093/med/9780190254131.003.0010 ◽

2017 ◽

Author(s):

Andri S. Bjornsson

Keyword(s):

Early Onset ◽

Body Dysmorphic Disorder ◽

Clinical Course ◽

Late Onset ◽

Age At Onset ◽

Treatment Interventions ◽

Course Of Illness ◽

Appropriate Treatment ◽

Onset Group ◽

Early Onset Group

This chapter reviews studies that have been conducted to determine the age at onset and course of illness of body dysmorphic disorder (BDD). Age at onset has been examined in two large samples, and the mean age at onset was the same in both studies (16.7 years). About two thirds of people had onset of BDD before age 18. There were more similarities than differences between the early-onset group (before age 18) and the later-onset group, although the early-onset group had a higher prevalence of attempted suicide than the late-onset group in both samples. The clinical course of BDD is often chronic unless appropriate treatment is received. These findings point to the need for early education on healthy body image and treatment interventions for BDD, especially among adolescents.

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The Constellation of Macrovascular Risk Factors in Early Onset T2DM: A Cross-Sectional Study in Xinjiang Province, China

Journal of Diabetes Research ◽

10.1155/2018/3089317 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Mingchen Zhang ◽

Jiangfeng Mao ◽

Ablikm Tuerdi ◽

Xiaoyun Zeng ◽

Li Quan ◽

...

Keyword(s):

Risk Factors ◽

Early Onset ◽

Late Onset ◽

Microvascular Complications ◽

Macrovascular Complications ◽

Control Group ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Onset Group ◽

Early Onset Group

Background. Despite a rapid popular of early onset type 2 diabetes (defined as diagnosis at <40 years old) recently, there is a lack of studies on this population in economically undeveloped area. We aimed to investigate the risk factors of macrovascular complications in the early onset T2DM patients in Xinjiang, China. Methods. A cross-sectional survey of 1736 consecutive patients with T2DM was conducted. Macrovascular complications and risk factors were documented. Another nondiabetic population matched with age and sex was as a control group. Logistic regression analysis was performed to obtain odds ratios (OR) for macrovascular complications in early and late onset T2DM, respectively. Results. The final analysis consisted of 1036 late onset and 219 early onset T2DM patients. The mean HbA1c in the early onset group was higher than that in the late onset group (9.1 ± 2.4% versus 8.3 ± 2.2%, P=0.039) despite a higher proportion of patients in the early onset group receiving insulin treatment (73.1% versus 58.7%, P<0.001). Compared to the control, early onset patients had higher blood pressure and worse lipid profiles (all P<0.01). More than half of the early onset T2DM patients already had macro- and microvascular complications, despite of their young age (39.5 ± 10.8) and short DM duration (6.6 ± 8.0). In the early onset group, women had a ~3-fold hazard of atherosclerotic plaques compared with men (OR 3.22, 95% CI 1.53–6.78). Conclusions. Patients with early onset T2DM have worse glycemic control and higher burden of atherogenic risk factors. The prevalence of macro- and microvascular complications is astonishingly high in these young adults with T2DM. Moreover, young women with T2DM are more susceptible to cardiovascular complications than their male counterpart.

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