FRI0080 CLINICAL CHARACTERISTICS OF PATIENTS WITH ELDERLY-ONSET RHEUMATOID ARTHRITIS (EORA)
Authors: B. Targonska-Stepniak, K. Grzechnik, K. Kolarz, D. Gagol, M. Majdan
Journal: Annals of the Rheumatic Diseases (2020)

Background: The onset of rheumatoid arthritis (RA) occurs usually between 35-50 years of age. Since the general population is ageing, beginning of RA in older age is more common. The term elderly onset of rheumatoid arthritis (EORA) describes the disease with onset at age over 60. The term younger-onset rheumatoid arthritis (YORA) refers to the disease with typical, earlier onset. Observational studies indicate, that substantial differences do occur between the two RA subtypes (EORA and YORA). Objectives: The goal of the study was to analyze the course of disease and treatment in EORA in comparison to YORA patients. Methods: The study was conducted in consecutive RA patients, treated in the Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Poland. The study group consisted of 113 patients (93 women, 20 men), with the mean (SD) age 59.4 (19.0), disease duration 12.9 (10.3) years. The cut off between EORA and YORA was set at 60 years of age. There were 63 (55.8%) EORA and 50 (44.2%) YORA patients. Demographic and clinical information was obtained through structured interview, review of medical records and laboratory tests. Disease activity was assessed based on joint counts and Disease Activity Score of 28 joints (DAS28). Results: In patients with EORA vs YORA, the mean (SD) age was 73.64 (6,6) vs 41.5 (13.7) (p&lt;0.001), the age of RA diagnosis 65.0 (4.2) vs 23.3 (4.8) (p&lt;0.001), RA duration 8.6 (5.4) vs 18.3 (12.3) years (p&lt;0.001). The group of patients with EORA compared with YORA, was characterized by: significantly higher number of men [respectively 16 (25.4%) vs 4 (8.0%)], unfavorable metabolic parameters [higher body mass index (BMI): 26.0 (5.8) vs 23.4 (4.1) kg/m 2 (p=0.04); serum uric acid: 5.7 (1.5) vs 4.4 (1.6) mg/dl (p=0.001)], as well as unfavorable parameters of RA activity [higher DAS28: 4.4 (1.5) vs 3.2 (1.6) (p&lt;0.001); higher tender joints count (TJC): 6.1 (6.2) vs 3.2 (3.7) (p=0.01); higher erythrocyte sedimentation rate (ESR) 45.9 (30.3) vs 24.1 (25.6) (p&lt;0.001) and white blood cell count (WBC): 8.3 (2.7) vs 7.0 (2.4)x10 3 /ml (p=0.01)]. At the time of assessment, remission or low disease activity was achieved in significantly fewer EORA vs YORA patients [15 (23.8%) vs 25 (50%) (p=0.007)]. In EORA patients methotrexate was used as the first disease modifying drug (DMARD) more often [54 (85.7%) vs 26 (52%) (p&lt;0.001)], the use of biological DMARDs was less common [5 (7.9%) vs 23 (46.0%) (p&lt;0.001)], as well as glucocorticoids (GC) [49 (77.8%) vs 47 (94.0%) (p=0.04)]. Significantly more patients with EORA than YORA, were affected by concomitant diseases [62 (98.4%) vs 41 (82%) (p=0.007)]. The prevalence of joint erosions, extra-articular manifestations and antibodies typical for RA (rheumatoid factor, RF-IgM and/or anti-citrullinated peptide, ACPA) did not differ significantly between the groups. Conclusion: In our study group, EORA patients were characterized by higher proportion of men, higher inflammatory parameters and higher disease activity, in comparison with YORA. In patients with EORA we also found unfavorable metabolic parameters and higher incidence of concomitant diseases, which could affect the method of treatment (less common use of GC and biological DMARDs). Disclosure of Interests: Bozena Targonska-Stepniak Consultant of: Berlin-Chemie Mennarini, Sandoz, Speakers bureau: KRKA, Sandoz, Krzysztof Grzechnik: None declared, Katarzyna Kolarz: None declared, Danuta Gagol: None declared, Maria Majdan Consultant of: Roche, Amgen, Speakers bureau: Roche, Amgen