Comparative study of elderly-onset versus young-onset rheumatoid arthritis: clinical features and treatment

Abstract

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%)(χ2=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%)(χ2=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%)(χ2=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%)(χ2=7.126 P=0.008). The synthetic or biologic traditional DMARDs(disease modifying anti-rheumatic drugs)were widely used in group YORA(78.9% and 31.1%)than in group EORA(40.0% and 10.0%)(χ2=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%)(χ2=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. Key words: Elderly onset rheumatoid arthritis; Disease activity