Background Rheumatoid arthritis (RA) can be categorized into late-onset RA and young-onset RA. Age at disease onset may implicate on disease activity, disease severity, comorbidity and also may have an impact on physicians' treatment choices.
Objectives The aim of this study was to assess clinical and laboratory features, disease activity, response, and biological treatment choices according to late-onset RA and young-onset RA patients.
Methods Hacettepe University Biologic Registry (HUR-BIO) is a single center biological registry since 2005. HUR-BIO biological dataset included demographic and clinical data and disease activity parameters. A total of 1087 (79.4% female) patients from the HURBIO registry were analyzed. Patients were categorized into two groups: young-onset RA (n=990, <60 years of age) and late-onset RA (n=97, ≥60 years of age) at disease onset. DAS-28 remission (<2.6) and low disease activity (<3.2) were assessed at last outpatient visit.
Results The female gender was similar in both age group (77.3% vs. 79.6%, p>0.05). Mean age of patients were 71.4±6.0 years in late-onset RA and 51.6±11.7 years in young-onset RA group. The median age at diagnosis of patients were 64 (range 60–85) years in late-onset RA and 40 (range17–59) years in young-onset RA patients. Mean disease duration between diagnosis of RA and first biologic therapy was longer in young-onset RA patients [7.7±7.3 vs. 2.7±2.6 years, p<0.001], but mean biologic duration was similar in both groups [29.9±27.5 vs. 38.4±37.1 months, p>0.05]. Rheumatoid factor and anti-citrullinated peptides positivity in late-onset RA and young-onset RA patients were; 56.2% vs. 63.8% (p>0.05) and 45.9% vs. 63.2%, p=0.008, respectively. At the baseline level, anti-TNF (61 (61.9%) vs. 827 (73.6%), p=0.014) drugs were less frequently used in late-onset RA, rituximab (21 (21.6%) vs 111 (11.3%), p=0.003) was more frequently used in late-onset RA, and abatacept (16 (16,5%) vs. 148 (15,1%), p>0.05) was used similar in both group. Change in DAS-28 score was similar [1.55±1.14 vs. 1.79±1.45 (p>0.05)], in late-onset RA and young-onset RA patients. Remission (29.5% vs. 38.6%, p>0.05) and low disease activity (52.5% vs. 55.4%, p>0.05) were similar in late-onset RA and young-onset RA patients. Biological switch ratio was significantly lower in late-onset RA group, 18.6% vs. 35.2%, p<0.001.
Conclusions Age may influence the clinician choice based on the efficacy and safety profile. Biologic drugs are effective in late-onset RA, as well. Rituximab was relatively more preferred in late-onset RA patients; may be related with administration of every 6 months and safety profile in malignancy risk. Patient and physician opinion on these choices should be evaluated in further studies.
Disclosure of Interest None declared