THU0112 The influence of age and sex on the progression of rheumatoid arthritis
Authors: I. Gjertsson, J. Nilsson, M. Andersson, M. Leu Agelii
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> In Europe, life expectancy is increasing and so does the incidence rheumatoid arthritis (RA), which peaks for both men and women at 70–79 years of age. Further, more than 50% of patients with RA are &gt;65 years of age. To correctly treat and handle all patients with RA irrespective of age there is a need to study the outcome and progression of the disease depending on age of onset as this, to our knowledge, is largely unknown. <h3>Objectives</h3> To study how age at onset of RA influence the course of disease in men and women. <h3>Methods</h3> This study included 2825 patients, 68% females, from the BARFOT (Better Anti-Rheumatic PharmacOTherapy) early RA cohort. Patients were divided into males and females and into the following age groups:&lt;40 years years (yr) n=415, 40–54 year n=658, 55–69 year n=986 and≥70 year n=766 at onset of disease and inclusion in the study. They were assessed at 3, 6 months and 1, 2, 5, 8 years. The following parameters were analysed: DAS28 (disease activity), VAS pain, VAS global health, 28 joint count of tender and swollen joints, respectively, ESR, rheumatoid factor (RF), antibodies to citrullinated proteins (APCA) and Health Assessment Questionnaire (HAQ). The median and 95% bootstrap confidence interval were calculated in <sup>MATLAB R2015a</sup> using the bias corrected and accelerated percentile method with 2000 bootstrap samples. Mann-Whitney U-test and Wilcoxon Rank test were used to compare groups, p&lt;0.01 was considered as significant due to multiple comparisons. <h3>Results</h3> At inclusion, there were no significant differences in DAS28, VAS global health, VAS pain or tender and swollen joint counts in any of the groups. From 3 months and onward, the DAS28 score were significantly lower for men compared to women in the age groups&lt;40 year, 55–69 year and ≥70 year, whereas in the age group 40–54 year there were no significant differences between the sex groups (figure 1). The lowest DAS28 score, at each assessment point, was seen for RF and ACPA positive men&lt;40 year and this group had a significantly lower DAS28 score at 8 years compared to all other groups except RF and ACPA negative men and women≥70 year. At the same time, the worst outcome was seen for RF positive women and for men≥70 year irrespective of RF, compared to all other groups. In the age groups&lt;40 year, 55–69 year and ≥70 year, both VAS pain and VAS global health were significantly lower in men compared to women from 3–6 month and onward However, no differences were obtained between the sexes in the age group 40–54 year. As expected, HAQ was significantly higher among women than men in all age groups. <h3>Conclusions</h3> Depending on age at onset, the course of disease, measured as DAS28, differs significantly where seropositive men&lt;40 year have the most favourable prognosis compared to both men and women≥70 year the worst. No differences in DAS28, VAS global health or pain was found between men and women aged 40–54 year, which is in contrast to previous studies<sup>1</sup> comparing men and women without considering the age of onset. The causes for these findings need to be further investigated. <h3>Reference</h3> [1] Patients with Early Rheumatoid Arthritis in the 2000s Have Equal Disability and Pain Despite Less Disease Activity Compared with the 1990s: Data from the BARFOT Study over 8 Years. J Rheumatol2017Jun;44(6):723–731. <h3>Disclosure of Interest</h3> None declared