Elderly-onset rheumatoid arthritis receives less aggressive therapies than young-onset rheumatoid arthritis in an Argentinian cohort.

OBJECTIVES: When rheumatoid arthritis (RA) starts after the age of 60 it is called elderly-onset rheumatoid arthritis (EORA) and when it starts earlier, young-onset rheumatoid arthritis. (YORA). There are few Latin American studies that compared both groups. The objective of the study was to evaluate differences in the clinical characteristics, evolution and treatment among patients with RA with onset before or after 60 years of age. MATERIALS AND METHODS: Observational study of patients with RA attended consecutively in four centers in Argentina. Sociodemographic data, comorbidities, clinical manifestations at diagnosis, presence of rheumatoid factor and/or anti-CCP (cyclic citrullinated peptide) and treatments received were collected. At the last visit, swollen and tender joints, assessment of disease activity by the patient and physician, the presence of radiographic erosions, and functional status using the HAQ-DI were recorded. RESULTS: 51 patients from each group were analyzed. The EORA group had a significantly higher proportion of smokers (58.8% vs. 35.3%, p = 0.029), cardiovascular history (54.9% vs. 21.6%, p = 0.001), abrupt onset (49% vs. 29.4%, p = 0.034) or with symptoms similar to PMR (19.6% vs. 0%, p = 0.001). Lower methotrexate doses were used in the EORA group: 19 mg (15-25) vs. 21.9 mg (20-25) (p = 0.0036) and more frequently did not receive bDMARDs or tsDMARDs. DISCUSSION AND CONCLUSIONS: The benefits of intensive treatment in patients with RA have been described. In this study, the use of DMARDs in the EORA group was less intensive, suggesting that advanced age constitutes a barrier in the therapeutic choice.

La artritis reumatoide de inicio en el anciano recibe terapias menos agresivas que la artritis reumatoide de inicio en el adulto en una cohorte argentina / Elderly-onset rheumatoid arthritis receives less aggressive therapies than young-onset rheumatoid arthritis in an Argentinian cohort

Antecedentes y objetivo: Cuando la artritis reumatoide (AR) comienza después de los 60años se denomina artritis reumatoide de inicio en el anciano, y cuando se inicia antes, artritis reumatoide de inicio en el adulto. Son escasos los estudios latinoamericanos que compararon ambos grupos. El objetivo del estudio fue evaluar diferencias en las características clínicas, en la evolución y en la elección terapéutica entre los pacientes con AR de inicio antes o después de los 60años. Materiales y métodos: Estudio observacional de pacientes con AR atendidos en forma consecutiva en cuatro centros de Argentina. Se recolectaron datos sociodemográficos, comorbilidades, manifestaciones clínicas al diagnóstico, presencia de factor reumatoide y/o anti-proteínas cíclicas citrulinadas (PCC) y tratamientos recibidos. En la última visita se registraron las articulaciones tumefactas o dolorosas, la evaluación de la actividad de la enfermedad por el paciente y por el médico, la presencia de erosiones radiográficas y el estado funcional mediante el HAQ-DI. Resultados: Se analizaron 51 pacientes de cada grupo. El grupo de AR del anciano tuvo significativamente mayor proporción de fumadores (58,8% vs 35,3%, p=0,029), de antecedentes cardiovasculares (54,9% vs 21,6%, p=0,001), de inicio abrupto (49% vs 29,4%, p=0,034) o con síntomas similares a la PMR (19,6% vs 0%, p=0,001), menores dosis de metotrexato: 19mg (15-25) vs 21,9mg (20-25) (p=0,0036) y con mayor frecuencia no recibieron FAMEb o FAMEsd. Discusión y conclusiones: Se han descrito los beneficios del tratamiento intensivo en pacientes con AR. En este trabajo, el empleo de FAME en el grupo de AR de inicio en el anciano fue menos intensivo, sugiriendo que la edad avanzada constituye una barrera en la elección terapéutica.(AU)

Objectives: When rheumatoid arthritis (RA) starts after the age of 60 it is called elderly-onset rheumatoid arthritis (EORA) and when it starts earlier, young-onset rheumatoid arthritis (YORA). There are few Latin American studies that compared both groups. The objective of the study was to evaluate differences in the clinical characteristics, evolution and treatment among patients with RA with onset before or after 60years of age. Materials and methods: Observational study of patients with RA attended consecutively in four centers in Argentina. Sociodemographic data, comorbidities, clinical manifestations at diagnosis, presence of rheumatoid factor and/or anti-CCP (cyclic citrullinated peptide) and treatments received were collected. At the last visit, swollen and tender joints, assessment of disease activity by the patient and physician, the presence of radiographic erosions, and functional status using the HAQ-DI were recorded. Results: Fifty-one patients from each group were analyzed. The EORA group had a significantly higher proportion of smokers (58.8% vs. 35.3%, P=.029), cardiovascular history (54.9% vs. 21.6%, P=.001), abrupt onset (49% vs. 29.4%, P=.034) or with symptoms similar to PMR (19.6% vs. 0%, P=.001). Lower methotrexate doses were used in the EORA group: 19mg (15-25) vs. 21.9mg (20-25) (P=.0036) and more frequently did not receive bDMARDs or tsDMARDs. Discussion and conclusions: The benefits of intensive treatment in patients with RA have been described. In this study, the use of DMARDs in the EORA group was less intensive, suggesting that advanced age constitutes a barrier in the therapeutic choice.(AU)