Abstract
ObjectiveThe proportion of elderly patients with rheumatoid arthritis (RA) is continuously growing as a result of the increasing aging population. We compared disease activity between different age groups, and evaluated the clinical factors associated with high disease activity.MethodsThis cross-sectional study analyzed the data of RA patients enrolled in the Korean College of Rheumatology Biologics registry (KOBIO-RA) between 2012 and 2014. Disease activity between elderly (age ≥ 65 years) and non-elderly patients (age < 65 years) was compared, and the association of clinical factors with high disease activity was assessed using a multivariate logistic regression model.ResultsOf 1,227 patients in KOBIO-RA, 244 patients with RA were aged 65 years or over. In elderly patients, the proportion of men was higher (P = 0.012), and the duration of disease was longer (P < 0.001) compared with non-elderly patients. The elderly group showed a higher incidence of comorbidity (P < 0.001), and less use of methotrexate (P = 0.004). Assessment of disease activity using various composite measures showed a higher proportion of high disease activity in elderly patients than non-elderly patients. Longer disease duration, presence of comorbidity, and non-use of methotrexate were independently associated with high disease activity (P = 0.002, P < 0.001, and P = 0.029, respectively).ConclusionsAt enrollment of KOBIO-RA, elderly patients showed higher disease activity compared with non-elderly patients. Disease duration, use of methotrexate, and comorbidity are associated with disease activity control in Korean patients with RA.
Highlights
Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology, characterized by peripheral polyarthritis
Assessment of disease activity using various composite measures showed a higher proportion of high disease activity in elderly patients than non-elderly patients
Presence of comorbidity, and non-use of methotrexate were independently associated with high disease activity (P = 0.002, P < 0.001, and P = 0.029, respectively)
Summary
Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology, characterized by peripheral polyarthritis. As the aging population continues to grow, the mean age of RA patients in clinical studies has continuously increased for several decades. Because age is one of the major determinants in clinical decision-making, there are distinct considerations for treatment strategies and clinical outcomes for elderly patients with RA. Patients frequently have other medical conditions that restrict tight control of RA activity. It is difficult to determine the optimal treatment in elderly patients with comorbidities. Disease-modifying anti-rheumatic drugs (DMARDs) are beneficial to reach the target, elderly patients are at increased risk of developing side effects of DMARDs owing to organ dysfunction. Immune system aging makes elderly patients more susceptible to infection during immunosuppressive therapy [4]. Physicians often hesitate to use intensive treatment for elderly patients with RA
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