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Disease duration, not age at onset dictated burden between RA cohorts
Differences in disease burden between patients with late-onset rheumatoid arthritis and young-onset rheumatoid arthritis were a function of disease duration as opposed to age in a recent study.
Researchers interpreted data from 9,541 patients with rheumatoid arthritis (RA) enrolled in the German Collaborative Arthritis Centers database from 2007 to 2009. Patients were stratified based upon age as either late-onset RA (LORA), aged older than 65 years (n=1,551); or young-onset RA (YORA), onset at or before age 65 years (n=7,990). Researchers then conducted matched analyses for patients by disease duration and sex (n=1,551 pairs; mean disease duration, 4.1 years; 69.4% women) to assess the impact of age, and also by age and sex (n=1,158 pairs; mean disease duration, 20.1 years, YORA; mean disease duration, 3.4 years, LORA; 72.5% women) to examine disease duration.
When examining patients of similar age, YORA patients showed higher disease activity (DAS 28; 3.2%-5.1%) (39.4% vs. 31.6%), diminished functional capacity assessed by the Hannover Functional Status Questionnaire (≤50) (36% vs. 21.6%) and less time in remission (30.4% vs. 37.8%) compared with LORA patients. The YORA cohort also had more comorbidities, including osteoporosis, gastritis, chronic renal disease and cardiovascular disease.
Disease severity (7%, YORA vs. 7.2%, LORA), remission rates (39.2% vs. 38.1%) and global health or pain intensity (17% vs. 16.6%) were similar when researchers compared groups for disease duration.
Regardless of disease duration or age, YORA patients reported more fatigue and sleep disorders, while LORA patients received fewer synthetic or biologic disease-modifying antirheumatic drugs.
“According to our data, age at onset of rheumatoid arthritis appears not to be the most important factor for differences in disease burden, but rather disease duration,” the researchers concluded. “The significantly smaller number of LORA patients who received treatment with biologic agents … reflects more conservative drug prescriptions in the elderly and may indicate a treatment deficit.”