Background The rate of aging (percentage of population aged 65 years and over) in Akita Prefecture is 33.8% (26.6% for the whole of Japan), the highest throughout Japan. The Akita Orthopaedic Group on Rheumatoid Arthritis (AORA) was established in 2010. Since then, patients have been enrolled every year to prepare the registry.
Objectives To compare patient characteristics as well as clinical effectiveness between the treatments with and without use of methotrexate (MTX) and a biological (BIO) using the data of the AORA registry.
Methods The subjects were 2,016 patients enrolled in the Akita registry in 2015. The subjects included 403 men and 1,613 women. According to the use of MTX and BIO, 2,016 patients were divided into the group treated with no use of MTX or BIO (group A), that treated with BIO, but no use of MTX (group B), that treated with MTX, but no use of BIO (group C), and that treated with MTX and BIO (group D).
Results The subjects were grouped into group A (n=673), B (n=153), C (n=805), and D (n=385). MTX was used in 59.0% and BIO was used in 26.7% of all patients. The mean ages were 69.6 years (group A), 65.7 years (group B), 65.6 years (group C), and 62.6 years (group D). The aging rates were 67.9% (group A), 55.6% (group B), 56.8% (group C), and 48.3% (group D), which shows that aging was more advanced in group A.
The rates of patients with a complication of hypertension, diabetes, respiratory disease, cerebrovascular disease, heart disease or malignant tumour were 52.0% (group A), 54.2% (group B), 45.5% (group C), and 40.8% (group D). The incidence of complication was the lowest in group D.
The rates of patients who received one or more of conventional synthetic disease-modifying antirheumatic drugs (cs DMARDs) other than MTX were 79.0% (group A), 42.5% (group B), 39.9% (group C), and 19.2% (group D). Although bucillamine and salazosulfapyridine were frequently used in any group, concomitant use of tacrolimus was remarkable in group A and C, while that of iguratimod was remarkable in groups C and D. The rate of use of a prednisolone (PSL), was significantly higher in group B. The dose of PSL was significantly higher in group A. In regard to BIO, three drugs of etanercept, tocilizumab, and abatacept accounted for 90% in group B. In group D, etanercept and tocilizumab were also frequently used, followed by infliximab, adalimumab, golimumab and abatacept.
In DAS28ESR, the rate of combined low disease activity and remission was significantly higher in group D. The mean values of C-reactive protein (CRP) (mg/dL) were 0.61 (group A), 0.52 (group B), 0.47 (group C), and 0.35 (group D), which shows that the mean value was significantly higher in group A than group D. The mean values of matrix metalloproteinase 3 (MMP3) (ng/dL) were 119.0 (group A), 130.6 (group B), 100.7 (group C), and 88.9 (group D), which shows that the mean value was significantly higher in group A and B than group C and D.
Conclusions Using the AORA registry, we compared patient characteristics as well as clinical effectiveness between the treatments with and without use of MTX and BIO. Since in group A, neither MTX nor BIO could be used in most patients, one had to practically rely on PSL. The study suggests that remission needs to be achieved prior to increase in complication due to aging.
Population census in Japan, 2015.
Disclosure of Interest None declared