Eye-openers for advanced management of elderly-onset rheumatoid arthritis

Objectives: 

To investigate whether clinical outcomes and patient-reported outcomes (PROs) differ over 2 years based on the age of onset of RA. 

Methods: 

All RA patients from the tREACH trial, a multicentre, stratified, single-blinded trial with a treat-to-target management approach and a fixed medication protocol were included. The age of disease onset was categorized into young-onset RA (YORA) (<45 years, n ¼ 119), middle-aged onset RA (MORA) (45–65 years, n ¼ 208) and elderly-onset RA (EORA) (>65 years, n ¼ 98) at the time of diagnosis. Mixed models were used to compare clinical outcomes and PROs over time. The following PROs were included: pain (Numeric Rating Scale), fatigue (visual analogue scale), functional ability (HAQ-Disability Index, HAQ-DI), quality of life (European Quality of Life 5-Dimensions 3-Levels, EQ-5D-3L), and possible depression (Hospital Anxiety and Depression Scale-Depression, HADS-D) or anxiety disorder (HADS-Anxiety, HADS-A). 

Results: 

At diagnosis, EORA patients had more swollen joints, erosions and comorbidities than younger patients. However, disease activity remained similar across age groups at diagnosis and over time. After 2 years of follow-up, bDMARD usage was 30%, 30% and 15% in YORA, MORA and EORA patients, respectively. EORA patients also experienced less pain and fatigue over time compared with YORA patients [1 (95% CI 0.5–1.6) and 17.3 mm (11.3–23.4) lower] and MORA patients [0.6 (0.1–1) and 5.8 mm (0.7–10.9) lower]. No other clinically relevant PRO differences were observed. 

Conclusion: 

Despite unfavourable prognostic factors at diagnosis, EORA patients have similar outcomes compared with their younger counterparts if a treat-to-target management approach is applied. Notably, fewer EORA patients required bDMARDs to reach the same treatment target.