脊柱关节炎 (SpA) 通常见于年轻男性患者，但也可在老年患者中诊断出来。这些病例对应于晚发性 SpA (LoSpA)，有两种主要临床表现：中轴型 SpA 和外周型 SpA。另一种日益常见的情况是患有 SpA 多年的老年患者。 LoSpA 的治疗管理与早发性疾病患者的治疗非常相似，结合了非药物治疗和药物治疗。可用于 LoSpA 的治疗包括非甾体抗炎药 (NSAID) 和针对 TNFα 或 IL-17A 的生物制剂。 Janus 激酶抑制剂 (JAKi) 最近在 SpA 市场上推出。 TNF抑制剂和IL-17抑制剂是治疗早发性SpA非常有效的药物。靶向治疗的有效性和安全性尚未在 LoSpA 或老年患者中进行专门评估，因此对于这些患有合并症和/或多药治疗的患者需要谨慎。根据间接数据，与早发性疾病相比，生物制剂治疗 LoSpA 的效果似乎较差。同时，建议在该年龄段开始使用这些药物之前仔细评估感染、恶性肿瘤和心血管事件的风险。 JAKi 可用于 LoSpA，但根据美国食品和药物管理局 (FDA) 和欧洲药品管理局 (EMA) 最近的建议，仅适用于选定的患者。当考虑到这种情况的发生率预计会随着年龄的增长而增加时，当然是时候将该患者类别视为 SpA 谱系中的一个独特亚组了。因此，需要进行评估该年龄段目标药物的具体研究。© 2023。作者，获得 Springer Nature Switzerland AG 的独家许可。

Spondylarthritis (SpA) is generally observed in young male patients but can be diagnosed in older patients. These cases correspond to late-onset SpA (LoSpA) with two main clinical presentations, axial and peripheral SpA. Another increasingly common situation is that of older patients who have had SpA for many years. The therapeutic management of LoSpA is quite smilar to the management of patients with an early-onset disease, combining both non-pharmacological and pharmacological treatments. The treatments that can be used in LoSpA include non-steroidal anti-inflammatory drugs (NSAIDs) and biological agents targeting TNFα or IL-17A. Janus kinase inhibitors (JAKi) were recently introduced on the market for SpA. TNF inhibitors and IL-17inhibitors are very effective drugs in early-onset SpA. The effectiveness and safety of targeted therapies have not been specifically evaluated in LoSpA or older patients, and thus caution is required for these patients with comorbidities and/or polymedication. According to indirect data, biological agents seem to be less effective in LoSpA compared with early-onset disease. In parallel, a careful evaluation for the risk of infection, malignancy and cardiovascular events is recommended before initiating these drugs in this age category. JAKi may be used in LoSpA, but only in selected patients according to recent recommendations from the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA). When considering that the prevalence of such situations is expected to increase as ageing progresses, it is certainly time to consider this patient category as a distinct subgroup within the spectrum of SpA. Specific studies evaluating targeted agents in this age category are thus desirable.© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.