Do patients with older onset rheumatoid arthritis receive less aggressive treatment than younger patients

Zuhre Tutuncu ¹, George Reed ², Joel Kremer ³ and Arthur Kavanaugh ^1*

¹ UCSD, United States
² U Mass, United States
³ Albany Medical College, United States

^* To whom correspondence should be addressed. E-mail: akavanaugh{at}ucsd.edu.

Accepted 7 January 2006

Abstract

Background and Objective: Rheumatoid Arthritis (RA) among elderly persons is an increasingly important health concern. Despite several cross-sectional studies, it has not been clearly established if there are important clinical differences between elderly onset rheumatoid arthritis (EORA) and younger onset rheumatoid arthritis (YORA). We utilized the Consortium of Rheumatology Researchers of North America (CORRONA) database, a database generated by rheumatologist investigators across the USA, to compare disease activity and treatment in EORA versus YORA.

Method: From a database of 9381 RA patients, 2101 RA patients with disease onset after age 60 (EORA) were matched, based on disease duration, with 2101 RA patients with disease onset between ages of 40 and 60 (YORA). The primary outcome measures were the proportion of patients on methotrexate, multiple disease modifying drugs (DMARD), and biologic agents (etanercept, infliximab, adalimumab, kineret) in each group.

Results: Disease activity and severity slightly differed between groups. For example: HAQ disability index (HAQ DI): 0.30 (EORA) vs. 0.35 (YORA); tender joint count (TJC): 3.7 (EORA) vs. 4.7 (YORA); swollen joint count (SJC): 5.3 (EORA) vs. 5.2 (YORA); DAS28: 3.8 (EORA) vs. 3.6 (YORA); patient global assessment (PGA): 29.1 (EORA) vs. 30.9 (YORA), physician global assessment (PhGA): 24.9 (EORA) vs. 26.3 (YORA); patient pain assessment (PPA): 31.4 (EORA) vs. 34.9(YORA). Regarding therapy, methotrexate use was slighlty more common among EORA patients (63.9% EORA vs. 59.6% YORA), although the mean methotrexate dose among YORA was higher than EORA. The percentage of EORA patients who were on multiple DMARD therapy (30.9 %) or on biologic agents (25 %) was significantly lower compared with YORA patients (40.5 % and 33.1 % respectively, p<0.0001). Toxicity related to therapy was very minimal in both groups, while toxicities related to methotrexate were more common in the YORA group.

Conclusion: This study demonstrates that EORA patients receive biologic therapy and combination DMARD therapy less frequently than YORA patients, despite identical disease duration and comparable disease severity and activity.

Keywords: Tunor necrosis factor, biologic agents, elderly, rheumatoid arthritis, treatment

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