Background The number of elderly patients suffering from rheumatoid arthritis (RA) is expected to rise in the coming years. The clinical presentation of elderly–onset RA (EORA) patients frequently differs from that of younger-onset RA (YORA) patients. EORA patients more often present with acute onset of the disease dominated by stiffness and pain of the shoulder and/or hip area. They often complain of constitutional symptoms and impairment in daily activities. Musculoskeletal ultrasonography is an established tool for diagnosis and follow-up of RA patients. However, specific knowledge about sonographic findings in patients with EORA is still scarce.
Objectives The aim of this study was to investigate by power doppler (PD) ultrasonography the anatomical structures affected in patients with newly-developed EORA to clarify the distinctive sonographic features of EORA.
Methods In this study, we included consecutive patients in whom a diagnosis of RA was established according to 2010 ACR/EULAR classification criteria. EORA was defined as onset at ≥75 years of age and YORA as onset at <75 years. Before the beginning of therapy, we evaluated the positivity of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies and Disease Activity Score in 28 joints using the erythrocyte sedimentation rate (DAS28-ESR), and the Health Assessment Questionnaire (HAQ) score. PD ultrasonography was performed in the clinically dominant side of the shoulder (long head biceps tendon [LHBT], subacromial-subdeltoid bursa, and gleno-humeral joint), wrist, metacarpophalangeal (MP) joints, and knee joints. PD signals were graded using a semiquantitative scoring method, which consisted of a scale of 0-3, and the sum of PD scores of a single joint component (total score) was calculated for each joint. Correlations between disease activity variables and ultrasonographic abnormalities were analyzed using Spearman's correlation coefficient and proportions were calculated by Fisher's exact test.
Results EORA was diagnosed in 36 patients (mean age 82.4±5.6 years, 72.2% women, 34.3% positive for anti-CCP) and YORA in 50 patients (mean age 53.5±13.8 years, 76.0% women, 58.0% positive for anti-CCP). A significantly higher number of EORA patients had a positive PD signal in the shoulder joint (88.9% versus 48.0%, p <0.001) than YORA patients (Fig. 1), and among the shoulder components, LHBT revealed the highest positive ratio (77.7% versus 32.0%, p <0.001). There were no significant PD signal differences between the two groups for the remainder of the examined joints. In EORA patients, no difference was seen between anti-CCP positive and negative groups concerning positive proportion of PD signals of the shoulder joints (91% and 87%, respectively, p=1.00) including LHBT component, as well as of the rest of the studied joints. According to correlation analysis, total score for the shoulder joint was significantly associated with DAS28-ESR and HAQ score (r=0.58, p<0.05 and r=0.60, p<0.05, respectively) in EORA patients.
Conclusions In patients with EORA, shoulder joint inflammation, especially LBT tenosynovitis, was a primary manifestation and contributed to increasing disease activity and functional disability.
Disclosure of Interest None declared