Late-onset RA Patients Face Greater Decline in Physical Function and higher incidence of adverse events, finds research

This chronic autoimmune disease is characterized by progressive disability and joint inflammation. Patients whose disease starts at ≥65 years are termed as LORA, while YORA is defined in the setting where onset happens when less than 65 years. The objective of the study was to compare the treatment outcomes and long-term physical function in both these groups.

The study assessed data from the IORRA cohort. This comprises patients who were diagnosed early with rheumatoid arthritis and whose disease duration was less than 2 years. The patients are classified into LORA and YORA depending on age at onset of disease. Outcome measures of this study consisted of change in Clinical Disease Activity Index (CDAI) and Japanese version of the Health Assessment Questionnaire (J-HAQ). The adverse event rates assessed the secondary outcome of the five-year follow-up.

Main Results

A total of 813 LORA patients and 2,457 YORA patients with a median age of 71 years and 51 years, respectively, were enrolled in the study. Main results are presented below:

Medication Use

• The use of methotrexate was 70.6% in LORA patients and 81.6% in YORA patients.

• Biological DMARDs were prescribed in 8.4% of LORA patients versus 19.4% of YORA patients.

• Glucocorticoids were used in 38.0% of LORA patients and 32.0% of YORA patients.

Disease Activity (CDAI):

• Both arms achieved significant early gains in CDAI scores.

• By Year 5, mean CDAI scores were similar for both treatments: LORA at 4.39 and YORA at 4.03, showing equal disease activity control.

Physical Function (J-HAQ):

• J-HAQ score of YORA settled below 0.5 after Year 2.

• The J-HAQ score for LORA gradually increased through the study to a mean of 0.56 at Year 5 vs. 0.33 for YORA.

Adverse Events:

• The frequency of adverse events was significantly higher with LORA.

• Adjusted hazard ratios for death and malignancy were 4.70 and 2.58, respectively, for LORA compared to YORA.

In conclusion, patients with late-onset rheumatoid arthritis demonstrated similar disease activity improvements as younger-onset patients over five years. However, LORA patients experienced a greater decline in physical function and faced a higher incidence of adverse events, emphasizing the need for tailored treatment strategies to improve long-term outcomes in this population.

Reference:

Sugitani N, Tanaka E, Inoue E, Abe M, Sugano E, Saka K, Ochiai M, Yamaguchi R, Ikari K, Yamanaka H, Harigai M. Higher risk of poor functional outcome and unfavorable clinical events for late-onset rheumatoid arthritis: results from the IORRA cohort. Rheumatology (Oxford). 2024 Dec 16:keae673. doi: 10.1093/rheumatology/keae673. Epub ahead of print. PMID: 39680892.