This study aims to compare characteristics between late-onset rheumatoid arthritis (RA) and young-onset RA and determine the association between age at disease onset and disease severity. We cross-sectionally studied 971 patients at the time of entry into the Ontario Best Practices Research Initiative, a registry of RA patients followed up in routine care. We restricted patients to ≤5 years of disease duration. Late-onset RA was defined as an onset ≥60 years of age and young-onset RA <60 years. Group differences were compared, and multivariate linear regression models were used to test the influence of age at onset on Disease Activity Score in 28 Joints with erythrocyte sedimentation rate (DAS28-ESR), Clinical Disease Activity Index (CDAI), and Health Assessment Questionnaire (HAQ) scores. The swollen joint count (6.2 vs. 5.3), acute phase reactants (C-reactive protein (CRP) 17.4 vs. 11.8 mg/L, ESR 30.6 vs. 21.5 mm/h), and comorbidity burden were higher in late-onset RA compared to young-onset RA (p < 0.01). Mean DAS28-ESR (4.6 vs. 4.3) and HAQ (1.2 vs. 1.1) scores were higher in late-onset RA patients (p < 0.05). Late-onset RA patients received more initial disease-modifying antirheumatic drug (DMARD) monotherapy and corticosteroids in comparison to greater DMARD/biologic combination therapy in young-onset RA patients (p < 0.05). Adjusted multivariate analyses showed that late-onset RA was independently associated with higher mean DAS28-ESR and HAQ scores, but not CDAI. Late-onset RA patients have greater disease activity that may contribute to disability early in the disease course. Despite this, initial treatment consists of less combination DMARD and biologic use in late-onset RA patients. This may have implications for future response to therapy and development of joint damage, disability, and comorbidities in this group.
Age of disease onset Disease activity Elderly onset Rheumatoid arthritis
This is a preview of subscription content, log in to check access.
This study was approved by the local ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
All persons gave their informed consent prior to their inclusion in the study.
Myasoedova E, Crowson CS, Kremers HM et al (2010) Is the incidence of rheumatoid arthritis rising?: results from Olmsted County, Minnesota, 1955–2007. Arthritis Rheum 62:1576–1582CrossRefPubMedPubMedCentralGoogle Scholar
Turkcapar N, Demir O, Atli T et al (2006) Late onset rheumatoid arthritis: clinical and laboratory comparisons with younger onset patients. Arch Gerontol Geriatr 42(2):225–231CrossRefPubMedGoogle Scholar
El-Labban AS, Omar HA, El-Shereif RR, Ali F, El-Mansoury TM (2010) Pattern of young and old onset rheumatoid arthritis (YORA and EORA) among a group of Egyptian patients with rheumatoid arthritis. Clin Med Insights Arthritis Musculoskelet Disord 20(3):25–31CrossRefGoogle Scholar
Mueller RB, Kaegi T, Finckh A et al (2014) Is radiographic progression of late-onset rheumatoid arthritis different from young-onset rheumatoid arthritis? Results from the Swiss prospective observational cohort. Rheumatology (Oxford) 53(4):671–677CrossRefGoogle Scholar
Innala L, Berglin E, Möller B et al (2014) Age at onset determines severity and choice of treatment in early rheumatoid arthritis: a prospective study. Arthritis Res Ther 16(2):R94CrossRefPubMedPubMedCentralGoogle Scholar
Arnold MB, Bykerk VP, Boire G et al (2014) Are there differences between young- and older-onset early inflammatory arthritis and do these impact outcomes? An analysis from the CATCH cohort. Rheumatology (Oxford) 53(6):1075–1086CrossRefGoogle Scholar
Calvo-Alén J, Corrales A, Sánchez-Andrada S, Fernández-Echevarría MA, Peña JL, Rodríguez-Valverde V (2005) Outcome of late-onset rheumatoid arthritis. Clin Rheumatol 24(5):485–489CrossRefPubMedGoogle Scholar
Spinel-Bejarano N, Quintana G, Heredia R et al (2013) Comparative study of elderly-onset rheumatoid arthritis and young-onset rheumatoid arthritis in a Colombian population: clinical, laboratory and HLA-DRB1 findings. Clin Exp Rheumatol 31(1):40–46PubMedGoogle Scholar
Khanna D, Ranganath VK, Fitzgerald J et al (2005) Increased radiographic damage scores at the onset of seropositive rheumatoid arthritis in older patients are associated with osteoarthritis of the hands, but not with more rapid progression of damage. Arthritis Rheum 52(8):2284–2292CrossRefPubMedGoogle Scholar
Camacho EM, Verstappen SM, Lunt M, Bunn DK, Symmons DP (2011) Influence of age and sex on functional outcome over time in a cohort of patients with recent-onset inflammatory polyarthritis: results from the Norfolk Arthritis Register. Arthritis Care Res (Hoboken) 63(12):1745–1752CrossRefGoogle Scholar
Cho SK, Sung YK, Choi CB et al (2012) Do patients with elderly-onset rheumatoid arthritis have severe functional disability? Semin Arthritis Rheum 42(1):23–31CrossRefPubMedGoogle Scholar
Huscher D, Sengler C, Gromnica-Ihle E et al (2013) Clinical presentation, burden of disease and treatment in young-onset and late-onset rheumatoid arthritis: a matched-pairs analysis taking age and disease duration into account. Clin Exp Rheumatol 31(2):256–262PubMedGoogle Scholar
Teoh L, Suppiah R, Gow P (2014) Late-onset rheumatoid arthritis in the Counties Manukau District Health Board region of New Zealand: an observational study of treatment. N Z Med J 127(1407):40–48PubMedGoogle Scholar
Anyfanti P, Pyrpasopoulou A, Triantafyllou A et al (2014) Acute inflammatory arthritis in the elderly; old flames, new sparks. Hippokratia 18(3):231–233PubMedPubMedCentralGoogle Scholar
Dejaco C, Duftner C, Wipfler-Freissmuth E, Weiss H, Schneider T, Schirmer M (2013) Elderly- versus younger-onset rheumatoid arthritis: higher levels of ultrasound-detected inflammation despite comparable clinical disease activity. Arthritis Care Res (Hoboken) 65(2):304–308CrossRefGoogle Scholar