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A recent study published in Rheumatology has shed light on the differences in treatment outcomes between late-onset rheumatoid arthritis (LORA) and younger-onset rheumatoid arthritis (YORA). The study found that while disease activity improved similarly in both groups over a five-year period, LORA patients experienced a greater decline in physical function and a higher frequency of adverse events. These findings emphasize the unique challenges faced by older adults with rheumatoid arthritis and the need for tailored treatment strategies to optimize their outcomes.
The study, led by Naohiro S. and colleagues, analyzed data from the IORRA cohort, which included patients with early-stage RA (disease duration <2 years) categorized as LORA (onset at age ≥65) or YORA (onset at age <65). The cohort consisted of 813 LORA patients with a median age of 71 years and 2,457 YORA patients with a median age of 51 years.
Both groups achieved significant early gains in disease activity, measured by the Clinical Disease Activity Index (CDAI), and showed similar mean CDAI scores at five years (4.39 for LORA vs. 4.03 for YORA). However, physical function, assessed using the Japanese version of the Health Assessment Questionnaire (J-HAQ), declined more in LORA patients over time.
There were also notable differences in medication use. Methotrexate, the cornerstone of RA treatment, was used less frequently in LORA patients (70.6% vs. 81.6%), as were biological DMARDs (8.4% vs. 19.4%). In contrast, glucocorticoids were used more often in the LORA group (38.0% vs. 32.0%).
The study found that LORA patients experienced significantly higher rates of adverse events compared to YORA patients. The adjusted hazard ratios for death and malignancy were 4.70 and 2.58, respectively, for LORA patients. These findings suggest that the higher frequency of adverse events may stem from age-related factors such as comorbidities or reduced medication tolerance.
The study concludes that while LORA and YORA patients achieve similar disease activity control, older adults with RA face unique challenges, including worse functional outcomes and greater risks of adverse events. As the population ages, these findings underscore the importance of individualized treatment strategies that balance disease control, medication tolerability, and long-term physical function preservation in older adults with RA.
By focusing on tailored approaches, clinicians may improve the quality of care and outcomes for this vulnerable patient population.