Background Elderly-onset rheumatoid arthritis (EORA) is defined as rheumatoid arthritis (RA) with onset at age 60 or over. In addition to population -growth in the elderly, EORA is also increasing. EORA shows some peculiarities. One of them is tendency for the onset to be acute and infectious-like.
Objectives To identify the clinical features of EORA started with the acute onset, accompanied by constitutional symptoms including high fever and weight loss.
Methods 62 early EORA patients (>65 years) who first visited our department from April in 2008 were reviewed. Of the 62 EORA patients, 11 patients with abrupt onset were enrolled: 8 women, 3 men age from 66-81 (mean 74±3.4). The patients were diagnosed as RA if they met the 2010 ACR/EULAR criteria or 1987 ACR revised criteria. Clinical, laboratory, and radiographic characteristics at onset and after follow up of 3 years are presented.
Results An initial clinical presentation resembles polymyalgia rheumatica in 3 patients and purulent arthritis in 2 patients. The average 28-joint disease activity score (DAS28) at the onset was 6.14±1.29. All patients had high CRP level (11.36±6.74 mg/dl) and only 4 patients (36.3%) were positive for anti-cyclic citrullinated peptides antibody (anti CCP). Methotrexate (MTX) were used in all patients and 5 needed biologic agent. Although the weekly MTX dose was low (6±1.29mg), adverse event occurred in 3 patients. The DAS 28 decreased at 3years (3.12±0.9). Because of rapidly progressive joint destruction of the hip and knee joints in 2cases within one year, they underwent toal joint arthroplasty. These 2 patients were anti CCP negative and it took several months before diagnosis of RA.
Conclusions EORA started with the acute onset had high disease activity. While constitutional symptoms led to delay in correct diagnosis, joint destruction rapidly progressed. EORA with the acute onset should be treated with appropriate DMARDs and biologic agents.
Disclosure of Interest None declared