Comparative study of elderly-onset versus young-onset rheumatoid arthritis: clinical features and treatment / 中华老年医学杂志

Objective To compare the clinical features and treatment between elderly onset rheumatoid arthritis(EORA)and young onset rheumatoid arthritis(YORA).Methods The EORA patients (n=60)and the YORA patients (n =90)were compared regarding sex ratio,activity of pathogenetic condition,disease severity,extra-articular manifestations,complications,laboratory indexes,and therapeutic schedules.Results The female/male ratio was 36/24(1.50 ∶ 1.0)in group EORA,and 69/21(3.3 ∶ 1.0)in group YORA,with higher female/male ratio in in group YORA.The frequency of morning stiffness,proximal interphalangeal joint involvement and metacarpophalangeal joint involvement were lower in group EORA(53.3 ％,46.676％ and 61.67 ％) than in group YORA (72.2 ％,77.8 ％,81.11％) (x2 =5.521,15.385,6.960,P =0.018,0.000,0.008 respectively).Large joints involvement at onset of rheumatoid arthritis was higher in group EORA(38.33 ％)than in group YORA(18.89 ％)(x2=6.960,P=0.008).The joint swollen and tender counts were comparatively less (16.51 ± 7.34) and (15.92 ± 8.44) in group EORA than in group YORA(22.46 ± 7.58) and (23.8 ± 8.93) (t =5.080、5.740,all P =0.000) respectively.The accumulated disease activity score(DAS28)was higher in group EORA(5.86± 1.57)than in YORA(4.92± 1.64) (t=3.360,P =0.001).HAQ score was lower in group EORA(0.83 ± 0.85)than in group YORA (1.16±0.91) (t=2.43,P =0.02).Comorbid conditions such as osteoarthritis,osteoporosis,cardiovascular disease and chronic renal insufficiency were more frequent in group EORA (51.7 ％,31.7 ％,18.3 ％ and 15.00％)than in group YORA(27.8％,15.6％,5.6％ and 4.4％)(x2 =11.722,5.445,6.168,5.067,P=0.001,0.020,0.013,0.024).The positive rate of RF were more higher in YORA(70.00％)than in group EORA (48.33％)(x2 =7.126 P=0.008).The synthetic or biologic traditional DMARDs (disease modifying antirheumatic drugs)were widely used in group YORA(78.9％ and 31.1％)than in group EORA(40.0％ and 10.0％)(x2 =14.940,9.153,P =0.000,0.002).The more frequently used program with glucocorticoids hormonal therapy was received in group EORA(38.3 ％)than in group YORA(20.00 ％)(x2 =6.092 P=0.014) Conclusions EORA patients differs from YORA patients in many of ways,including a more balanced gender distribution,atypical presentation at onset of disease,more frequent involvement of large joints,seronegativity in a higher percentage,and less frequent positivity of anti CCP-antibody,which makes diagnosis more difficult in the earlier period.Therapy of EORA with DMARDs should be instituted based on disease activity,if there is no contraindication.

Clinical Characteristics of Elderly Onset Rheumatoid Arthritis

BACKGROUND: Elderly onset rheumatoid arthritis (EORA) affects people older than 60 years of age and is different from younger onset rheumatoid arthritis (YORA) in several aspects. EORA is seen in each sex equally, has more large joint involvement and is associated with a higher erythrocyte sedimentation rate (ESR). In this study, we compared the clinical and laboratory data of these two conditions. METHODS: Our subjects included 230 patients meeting the American College of Rheumatology criteria for rheumatoid arthritis. We compared the clinical manifestation, medication history and laboratory data including rheumatoid factor, anti-nuclear antibody, ESR, C-reactive protein and total sharp score of EORA and YORA. RESULTS: The male to female ratio was 1:2.5 in EORA and 1:5.6 in YORA (p=0.016). The mean age was 74+/-5.3 years in EORA and 47+/-8.9 years in YORA. ESR was higher for EORA (52.8+/-35.6 mm/hr) than for YORA (40.2+/-29.2 mm/hr) (p=0.004). A positive RF was seen more often in EORA (75%) than in YORA (67%) (p=0.027). Shoulder joint pain was more common in EORA (41.0%) than in YORA (21.6%) (p=0.001) as was knee joint pain, 77.1% and 48.8%(p<0.001), respectively. CONCLUSION: EORA showed a relatively higher incidence in males and had more large joint involvement than YORA. The higher abnormal values of ESR and rheumatoid factor seen in EORA might be associated with poor prognosis.

The Characteristics of Elderly Onset Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVES: Patients who develop rheumatoid arthritis over 60 years old(elderly-onset rheumatoid arthritis, EORA) are different from those of younger-onset disease(YORA). Several aspects are emphasized; more equal sex distribution, more often systemic complaints, more larger joints involvement, high ESR rates, and less rheumatoid factor positivity. We compared the clinical characteristics of EORA with those of YORA. METHODS: Five hundred and fifty-six patients who had met the ACR criteria for rheumatoid arthritis were studied. We compared the difference with clinical manifestation, disease activity markers, serologic markers including rheumatoid factor and anti-perinuclear factor, and radiologic changes between EORA and YORA. RESULTS: EORA : YORA ratio is 49 : 507, no difference between male and female ratio. The age at onset of EORA is 67.3 +/- .89 years old, YORA is 4.9 +/-10.5 years old, disease duration is not different in both groups. The ESR of EORA (47.65 +/-13.8) is higher than that of YORA ( 39.49+/-.1 ), the positivity of antiperinuclear factor is significantly increased in the EORA group as compared with YORA group. The comparisons of disease activity including Ritchie index; early RA in both groups showed significant difference only in rheumatoid factor titer. CONCLUSION: The EORA is similar to YORA except high ESR, high rheumatoid factor titer, and high positivity of antiperinuclear factor. However, we failed to demonstrate that the EORA runs different course with heterogeneous pathogenesis to the YORA.