AB0405 Clinical features and problems of elderly onset rheumatoid arthritis in ultra-ageing society –single centre retrospective cohort study-
Authors: T. Kurasawa, Y. Okada, A. Shibata, S. Saito, K. Chino, A. Okuyama, H. Takei, T. Kondo, K. Amano
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Japan is the ultra-ageing society ahead of any other country in the world, which ageing rate (the ratio of the population aged 65 and older to the total population) was reported to be 27.3% on October 1, 2016. The rate of aged patients, who followed up at the division of rheumatology in Saitama medical centre, had exceeded 40%. <h3>Objectives</h3> The aim of our study is to reveal recent clinical features and problems of elderly onset rheumatoid arthritis (EORA) patients for better management. <h3>Methods</h3> Patients had a diagnosis by 1987 classification criteria or 2010 ACR/EULAR criteria. We firstly listed up RA patients who were followed up our hospital from April 1 to September 30, and above aged 65 years old as of September 30. Then we retrospectively collected clinical information of EORA patients who onset above 60 years old, diagnosed and made starts of treatment in our hospital, and observed more than 6 months, from medical records. <h3>Results</h3> One hundred eighty eight EORA patients were enrolled in this study. Female were 116 (62.0%). Mean observation period from first visit until September 30, was 68 months. Rheumatoid factor positive rate was 67.0%. Anti-CCP antibody-positive was 68.2% (107/157), and most of them (65.5%, 70/107) had high antibody titer over 100 U/mL. At the time of diagnosis, average CRP was 3.1 mg/dL. Respiratory complications were seen in 26.1% (49 cases), including 28 interstitial lung disease, 10 COPD/emphysema, 7 non-tuberculous mycobacteriosis/obsolete tuberculosis, and 6 bronchiectasis. Other complications were diabetes 16.5% (past 25 cases, new 6), hypertension 38.3% (past 66, new 6), and hyperlipidemia 23.9% (past 33, new 12). Histories of cerebrovascular or cardiovascular events were seen in 10.6% (20 cases), and history of malignancy was seen in 6.9% (13 cases). During observation period, newly developed malignancy was seen in 14 cases (14.1/1000 person-years) including 4 MTX related lympho-proliferative disorders (MTX-LPD), 3 gastrointestinal cancer, 3 gynaecological cancer, 2 lung cancer, and so on. Infectious adverse event were occurred in 35 patients (35.3/1000 person-years). From the point of treatment, corticosteroids were prescribed in 32%, csDMARDs 88%, and biological DMARDs (BIO) 47%. Of 89 EORA patient treated with BIO, average DAS28-ESR was 5.77, and HAQ-DI 1.48 at the baseline. Twenty-nine cases were started to treat with BIO as monotherapy, 13 cases as switching to BIO from csDMARDs, and 47 as addition BIO to csDMARDs. During observation period, reasons of cessation of the first BIO were remission in 21, adverse events in 19 (7 infections, 6 injection-site/infusion reaction, 3 malignancies, and so on), insufficient response in 16, and patient's hope in 2. <h3>Conclusions</h3> RF/anti-CCP antibody positive rate was lower than general RA population, but slightly higher than previous reports on EORA.<sup>1)</sup> BIO could be discontinued in 24% of 89 patients who received BIO because of remission. On the other hand, the frequency of infection and malignancy was still higher in EORA patients. So it is necessary to adjust anti-rheumatic therapy for poor prognostic cases, and we should be careful to follow up EORA patients. <h3>References</h3> [1] Boeters DM, et al. Arthritis Res Ther. 2017May 31;19(1):115. [2] Sugimoto N, et al. Rheumatol Int. 2017Nov;37(11):1871–1878. <h3>Disclosure of Interest</h3> T. Kurasawa: None declared, Y. Okada: None declared, A. Shibata: None declared, S. Saito: None declared, K. Chino: None declared, A. Okuyama: None declared, H. Takei: None declared, T. Kondo: None declared, K. Amano Grant/research support from: Chugai Pharmaceutical Co. Ltd., Speakers bureau: Chugai Pharmaceutical Co. Ltd., Daiichi-Sankyo Co., Ltd., Pfizer Japan Inc., Mitsubishi Tanabe Pharma Corporation