Background Elderly-onset RA (EORA) is defined as the onset of RA at 65 years of age or older and Patients with EORA frequently present with acute onset of the disease dominated by stiffness and pain in the shoulder and their daily activities are generally impaired. However, specific knowledge on sonographic findings in patients with newly-developed EORA remains limited.
Objectives The aim of the present study was to clarify specific sonographic features in patients with new-onset EORA.
Methods We included consecutive patients who were diagnosed with RA according to the 2010 ACR/EULAR classification criteria. EORA was defined as a RA onset at ≥65 years of age and YORA as an onset at <65 years. Prior to the initiation of therapy, we evaluated positivity for anti-CCP antibodies as well as DAS28-ESR and HAQ score. Musculoskeletal ultrasonography was performed at the initial visit and the investigation sites included the dominant side of the shoulder (long head biceps tendon, subacromial-subdeltoid bursa, and glenohumeral joint), wrist, metacarpophalangeal (MP) joints, and knee joint. Gray scale (GS) and power Doppler (PD) signals were subjectively graded for each site using a semi-quantitative scoring method, which consisted of a scale of 0–3, and the sum of the GS scores of a single joint was calculated as the total GS score for each joint and the sum of PD scores as the total PD score. We investigated sonographic differences between EORA and YORA and the relationships between disease activity variables and ultrasonographic findings were analyzed in patients with EORA using Spearman's correlation coefficient. Proportions were calculated by Fisher's exact test.
Results EORA was diagnosed in 47 patients (mean age 79.4 ± 7.3 years) and YORA in 35 patients (age 48.1 ± 12.5 years). The positive ratios of GS and PD signals were 91.3% and 83.1%, respectively, at the shoulder joint in EORA patients, and both proportions were significantly higher than those in YORA patients (61.2% for GS [p<0.01] and 50.0% for PD [p<0.01]). The remainder of the examined joints including the wrist, MP and knee joints showed no significant differences in the GS or PD positive ratios between the two groups. We subsequently stratified EORA patients according to anti-CCP antibody positivity. The t-GS score of the shoulder joint was significantly higher in the anti-CCP negative group than in the positive group (4.6 ± 2.0 and 2.8 ± 2.5, respectively, p<0.05). However, the remainder of the examined joints showed no significant differences. Furthermore, no significant differences were observed between the two groups in terms of the t-PD scores of all joints. In EORA patients, the t-GS and t-PD scores of the shoulder joint strongly correlated with the HAQ score (r=0.72, p<0.0001, r=0.68, p<0.0001, respectively) and, among the shoulder joint components, long head biceps tendon showed the strongest correlation both in the t-GS and t-PDS scores (r=0.64, p<0.0001, r=0.55, p<0.001). The t-PD scores of the shoulder, wrist, and MP joints correlated with DAS 28-ESR (r=0.62, p<0.0001, r=0.43, p<0.05, r=0.38, p<0.05).
Conclusions Shoulder joint involvement was a specific feature in patients with EORA and contributed to functional disability and increased disease activity.
Soubrier et al. Elderly-onset rheumatoid arthritis. Joint Bone Spine 2010;77:290–6
Disclosure of Interest None declared