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.

Clinical Characteristics of Late-onset Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: Late-onset rheumatoid arthritis (LORA) refereed as the subset of rheumatoid arthritis with age of onset over 60 years old, seems to differ from younger onset disease (YORA) by more equal sex distribution, a higher frequency of abrupt disease onset, more large joints involvement, more extraarticular manifestation, erythrocyte sedimentation test (ESR), and less rheumatoid factor (RF) positivity. We need data of LORA in Korea because of lack of data. METHODS: Two hundred and forty-two patients were studied retrospectively. We compared the difference with clinical manifestation, disease activity markers, RF, ANA, and radiologic changes between LORA and YORA. Sums of ESR and C-reactive protein (CRP) during first year after diagnosis were calculated through area under curve. Radiologic joint damages were evaluated using modified Sharp score. RESULTS: The gender ratio (female/male) was 1.54 in LORA and 6.43 in YORA (p<0.001). The duration of the diagnosis was longer in LORA than in YORA (25.2+/-27.0 months, 18.5+/-22.2 months, p=0.048). Tender and swollen joint, and involvement of joints were not different in the groups. ESR, CRP, platelet, and RF were higher with LORA. Sums of ESR and CRP were higher in LORA than in YORA (403.7+/-252.2 mm/hr, 25.6+/-41.1 mg/dL vs 281.4+/-201.3, 12.0+/-15.0). There was no difference of modified Sharp score in both groups. CONCLUSION: The LORA has an equal gender ratio, longer morning stiffness and disease duration, and higher levels of RF, platelet, ESR, CRP, and summation of ESR and CRP, which suggests that LORA may have poorer prognosis than YORA.

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.