THU0136 VERY ELDERLY ONSET RHEUMATOID ARTHRITIS (VEORA): CLINICAL AND THERAPEUTIC IMPLICATIONS AFTER 80 YEARS
Authors: A. García Dorta, C. Almeida, H. D. Marta, L. Cáceres Martín, E. Trujillo, I. Ferraz-Amaro, J. C. Quevedo-Abeledo
Journal: Annals of the Rheumatic Diseases (2020)

Background: There are differences in the characteristics of patients with Rheumatoid Arthritis (RA) depending on their age at onset with two traditional groups: YORA (young onset RA) and EORA (elderly onset RA). These aspects have not been studied in cases of very late onset (≥ 80 years) Objectives: To describe the clinical characteristics, treatments and evolution at one year in “very elderly onset RA” (VEORA). Compare these characteristics with YORA (40-50 years) and EORA (60-70 years). Methods: Retrospective and longitudinal study of RA patients from 2 spanish hospitals. From their databases, VEORA patients were identified and their clinical characteristics were analyzed at onset, treatments at diagnosis and in the first 12 months, as well as DAS28-ESR activity after 1 year. These variables were compared between cases belonging to one of the hospitals and 2 control groups of YORA and EORA patients of the same center, matched by sex, diagnosis date ± 2 years, RF and / or ACPA status and presence of erosions in baseline Rx. Results: A total of 2790 records of RA patients were analyzed, identifying 59 cases of onset in “very elderly” (2% of the total). Table 1 shows its clinical, analytical characteristics and treatments at diagnosis. Table 1. Demographic and clinical data of the 59 VEORA patients n=59 Female, n(%) 43 (73) Age at onset, years 83 ± 3 Comorbidity Hypertension, n(%) 54 (92) Diabetes, n(%) 19 (32) CV disease 20 (34) Clinical and analytical data at diagnosis Acute onset, n(%) 26 (44) Polyarticular onset, n(%) 37 (63) Specific forms, n(%) 21 (36) Polymyalgia Rheumatica, n 16 RS3PE, n 5 Rheumatoid factor, n(%) 40 (68) ACPA, n(%) 24 (41) DAS28-ESR 5 (4,4-5,7) high activity, n(%) 32 (54) First visit treatment NSAIDs, n(%) 5 (9) Steroids, n(%) 55 (93) starting dose, mg/day* 10 (7,5-15) DMARD, n(%) 52 (88) Hidroxychloroquine 14 (24) Methotrexate 36 (61) starting dose, mg/week 10 (7,5-10) Combined therapy 5 (8) Elderly patients (EORA and VEORA), compared with YORA, presented with higher frequency hypertension and CV disease, higher elevation in acute phase reactants at the onset and disease activity at diagnosis. VEORA patients, compared to EORA, showed a higher frequency of dyslipidemia (p = 0.04). There were also no significant differences between VEORA and EORA in the distribution and type of joints affected, time to diagnosis, acute phase reactants or disease activity at the onset. A higher frequency of special forms (such as PMR or RS3PE) was close to statistical significance in the VEORA group (p = 0.054). Regarding initial treatment, both EORA and VEORA received steroidal treatment more frequently and a lower dose of Methotrexate during the first year. Biological treatments was also significantly higher in YORA (p=0,000). When comparing VEORA and EORA, differences related to the use of NSAIDs were found, lower in VEORA (p = 0.000), as well as in the maximum dose of Methotrexate reached in the next 12 months, higher in the EORA group (p = 0.01). No differences in adverse events with DMARDs were observed. DAS28-ESR and the number of patients in remission or low activity at one year showed no differences between EORA and VEORA, or between these groups and that of younger patients. Conclusion: There have been few differences in the comorbidity profile and clinical characteristics at the onset between VEORA and EORA patients. Despite the differences observed in its management (more conservative in EORA and VEORA vs YORA, and in VEORA vs EORA), we have not observed differences in DAS28-ESR activity after one year. Disclosure of Interests: Alicia García Dorta: None declared, Cristina Almeida: None declared, Hernández Díaz Marta: None declared, Laur Cáceres Martín: None declared, Elisa Trujillo: None declared, Iván Ferraz-Amaro Grant/research support from: Pfizer, Abbvie, Speakers bureau: Pfizer, Abbvie, MSD., Juan Carlos Quevedo-Abeledo: None declared