Background As aging society and treatment of rheumatoid arthritis (RA) progress, problem of elderly onset RA (EORA) raised up in developed countries recent decade. Number of patient who suffers RA in elderly days has increasing. Grasping characteristics of EORA compared to young onset RA (YORA) is beneficial information for daily clinical practice for RA.
Objectives RA patient's clinical courses were investigated from our small cohort study, and clinical characteristics of EORA were evaluated.
Methods 549 RA patients visited as RA as diagnosed with 2010 ACR/EULAR classification criteria since August 2010, when treat to target strategy (T2T) have been accepted in our clinic, and have continued to be treated consecutively. Our clinic is the only medical institute in where rheumatologists that is certified Japan College of Rheumatology work in the area that consists of hundred thousand of population.
In these, patients who had been thrown of methotrexate before first visit, and dead patients before November 2015 were eliminated, then 436 patients have been investigated in this study. Patients were classified according to age at onset. We defined EORA as their onset age is sixty-five or more. The other patients (YORA) were also classified according to age at last visit. Patient who is younger than 65-year-old was classified as yYORA, and another group was defined as oYORA. Average values of disease activity score with 28 joints with C-reactive protein (DAS28-CRP), CRP, patient's pain score with visual analogue scale (PS-VAS), and health assessment questionnaire (HAQ-DI), for first visit (@BL), six months later (@6M), and average value throughout follow up (@AV), concomitant methotrexate (MTX) and glucocorticoid (GCS) thrown ratio, and average dosage of these drugs for first 24 weeks were calculated and compared with Mann-Whitney's U-test, unpaired T-test and chi-square test among groups and two of the three groups.
Results 176 EORA, 123 oYORA, and 137 yYORA were picked up. Average DAS28-CRP were 3.83, 3.59, 3.71 @BL, 1.82, 1.85, 1.73 @6M, 1.99, 2.03, 2.22 @AV, while CRP were 1.61, 0.88, 0.83 @BL, 0.58, 0.46, 0.54 @6M, 0.73, 0.62, 0.57 @AV, and PS-VAS were 37.87, 30.73 33.74 @BL, 20.78, 17.32, 22.57 @6M, 25.79, 24.74, 26.19 @AV, and HAQ-DI were 0.53, 0.50, 0.26 @BL, 0.27, 0.20, 0.15 @6M, 0.46, 0.40, 0.26 @AV, for EORA, oYORA, and yYORA, respectively.
MTX and GCS thrown ratio were 47.7%, 38.9%, 45.3%, and 27.8%, 15.9%, 10.8% for EORA, oYORA, yYORA, respectively. Thrown dosage of MTX were 7.99, 8.25, 8.87mg, while GCS were 3.24, 3.07, 3.44mg, for EORA, oYORA, yYORA, respectively.
In Table 1, their statistical significances have been described.
Conclusions EORA patient has tendency to demonstrate higher CRP and PS-VAS at baseline than YORA, As well as CRP, DAS28-CRP is likely to demonstrate relatively higher, however, also demonstrates sensitive response for treatment including for GCS, then reduces PS-VAS as well as DAS28-CRP. However, elderly RA patient tends to remain in higher level of HAQ-DI than yYORA.
Disclosure of Interest None declared