Rheumatoid arthritis presentation in elderly patients: How different from the usual presentation?

Aim of the work

This work aimed to compare the outcomes between elderly- and younger-onset rheumatoid arthritis (EORA and YORA, respectively).

Patients and methods

This study included 140 RA patients recruited from the rheumatology outpatient clinic of Ain Shams University Hospitals. The study included 70 EORA (>60 years) patients and a similar number of YORA (<60 years) cases. Both groups were compared based on demographic data, clinical manifestations, disease activity markers, and drug history.

Results

Large joint arthritis and myalgia were higher in the EORA group (p < 0.0001) while small joint arthritis was higher in the YORA (p < 0.0001). The frequency of interstitial lung disease (ILD), rheumatoid nodules, and deformities was higher in the YORA group (p = 0.03, p = 0.03, and p = 0.02 respectively). Anti-citrullinated protein antibody (ACPA) positivity and erythrocyte sedimentation rate (ESR) were higher in YORA (p = 0.01). The disease activity scores (DAS28, SDAI, and CDAI) were higher in the YORA than in the EORA (p < 0.0001). YORA were significantly receiving sulfasalazine (34.3 %) and hydroxychloroquine (84.3 %) at a higher frequency than EORA (67.1 % and 8.6 %, p < 0.0001 and p = 0.02 respectively) while EORA were more receiving leflunomide (57.1 % vs 40 %; p = 0.04). Biologic therapy was received only by YORA patients.

Conclusion

EORA presents with distinct features from YORA, including a more insidious onset with myalgia and large joint affection making the diagnosis more challenging. EORA has a lower severe course with less deformities and disease activity with a tendency to be controlled by a single DMARD rather than combinations or biologics.