Elderly Onset Spondyloarthropathy and VEXAS Syndrome: A Case Report

We report the case of a 67-year-old male with a two-year history of inflammatory polyarthritis, fatigue, and low back pain. He also had a history of biopsy proven neutrophilic dermatosis in the past. On admission and examination, he had pallor. Laboratory evaluation showed macrocytic anaemia, elevated erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). MRI of Sacroiliac joints showed presence of bilateral sacroiliitis. Bone marrow examination showed the presence of cytoplasmic vacuolisation in myeloid and erythroid precursor cells. Genetic analysis confirmed a diagnosis of VEXAS syndrome. He improved with prednisolone and Sulfasalazine with no further relapse on follow up. This case report highlights the importance of considering VEXAS syndrome in older adults with presentation of spondyloarthritis and macrocytic anaemia. Early diagnosis and treatment with corticosteroids and steroid-sparing agents can lead to significant improvement in symptoms and are important for a good outcome.