1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Imanaka T, Shichikawa K, Inoue K, Shimaoka Y, Takenaka Y, Wakitani S. Increase
in age at onset of rheumatoid arthritis in Japan over a 30 year period. Ann Rheum Dis.
1997; 56(5): 313-6.
El-Labban AS, Omar HA, El-Shereif RR, Ali F, El-Mansoury TM. Pattern of Young
and Old Onset Rheumatoid Arthritis (YORA and EORA) Among a Group of
Egyptian Patients with Rheumatoid Arthritis. Clin Med Insights Arthritis
Musculoskelet Disord. 2010; 3: 25-31.
Arnold MB, Bykerk VP, Boire G, Haraoui BP, Hitchon, C, Thorne C, et al. Are there
differences between young- and older-onset early inflammatory arthritis and do these
impact outcomes? An analysis from the CATCH cohort. Rheumatology (Oxford).
2014; 53(6): 1075-86.
Tan TC, Gao X, Thong BY, Leong KP, Lian TY, Law WG, et al. Comparison of
elderly- and young-onset rheumatoid arthritis in an Asian cohort. Int J Rheum Dis.
2017; 20(6): 737-745.
Sugihara T, Ishizaki T, Hosoya T, Iga S, Yokoyama W, Hirano F, et al. Structural and
functional outcomes of a therapeutic strategy targeting low disease activity in patients
with elderly-onset rheumatoid arthritis: a prospective cohort study (CRANE).
Rheumatology (Oxford). 2015; 54(5): 798-807.
Krams T, Ruyssen-Witrand A, Nigon D, Degboe Y, Tobon G, Fautrel B, et al. Effect
of age at rheumatoid arthritis onset on clinical, radiographic, and functional outcomes:
The ESPOIR cohort. Joint Bone Spine. 2016; 83(5): 511-5.
Pease CT, Bhakta BB, Devlin J, Emery P. Does the age of onset of rheumatoid
arthritis influence phenotype?: a prospective study of outcome and prognostic factors.
Rheumatology (Oxford). 1999; 38(3): 228-34.
Tutuncu Z, Reed G, Kremer J, Kavanaugh A. Do patients with older-onset
rheumatoid arthritis receive less aggressive treatment? Ann Rheum Dis. 2006; 65(9):
1226-9.
Bukhari M, Lunt M, Barton A, Bunn D, Silman A, Symmons D. Increasing age at
symptom onset is associated with worse radiological damage at presentation in
patients with early inflammatory polyarthritis. Ann Rheum Dis. 2007; 66(3): 389-93.
Radovits BJ, Fransen J, Eijsbouts A, van Riel PL, Laan RF. Missed opportunities in
the treatment of elderly patients with rheumatoid arthritis. Rheumatology (Oxford).
2009; 48(8): 906-10.
Bajocchi G, La Corte R, Locaputo A, Govoni M, Trotta F. Elderly onset rheumatoid
arthritis: clinical aspects. Clin Exp Rheumatol. 2000; 18(4 Suppl 20): S49-50.
Smolen JS, Landewe RBM, Bijlsma JWJ, Burmester GR, Dougados M,
Kerschbaumer A, et al. EULAR recommendations for the management of rheumatoid
arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019
update. Ann Rheum Di., 2020; 79(6): 685-699.
Stoffer MA, Schoels MM, Smolen JS, Aletaha D, Breedveld FC, Burmester G, et al.
Evidence for treating rheumatoid arthritis to target: results of a systematic literature
search update. Ann Rheum Dis. 2016; 75(1): 16-22.
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The
American Rheumatism Association 1987 revised criteria for the classification of
rheumatoid arthritis. Arthritis Rheum. 1988; 31(3): 315-24.
Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010
Rheumatoid arthritis classification criteria: an American College of
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
Rheumatology/European League Against Rheumatism collaborative initiative.
Arthritis Rheum. 2010; 62(9): 2569-81.
Kameda H, Fujii T, Nakajima A, Koike R, Sagawa A, Kanbe K, et al. Japan College
of Rheumatology guideline for the use of methotrexate in patients with rheumatoid
arthritis. Mod Rheumatol. 2019; 29(1): 31-40.
Smolen JS, Breedveld FC, Schiff MH, Kalden JR, Emery P, Eberl G, et al. A
simplified disease activity index for rheumatoid arthritis for use in clinical practice.
Rheumatology (Oxford). 2003; 42(2): 244-57.
Prevoo ML, van't Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel
PL. Modified disease activity scores that include twenty-eight-joint counts.
Development and validation in a prospective longitudinal study of patients with
rheumatoid arthritis. Arthritis Rheum. 1995; 38(1): 44-8.
Rasch EK, Hirsch R, Paulose-Ram R, Hochberg MC. Prevalence of rheumatoid
arthritis in persons 60 years of age and older in the United States: effect of different
methods of case classification. Arthritis Rheum. 2003; 48(4): 917-26.
Kerr LD. Inflammatory arthropathy: a review of rheumatoid arthritis in older patients.
Geriatrics. 2004; 59(10): 32-5; quiz 36.
Yazici Y, Paget SA. Elderly-onset rheumatoid arthritis. Rheum Dis Clin North Am.
2000; 26(3): 517-26.
Turkcapar N, Demir O, Atli T, Kopuk M, Turgay M, Kinikli G, et al. Late onset
rheumatoid arthritis: clinical and laboratory comparisons with younger onset patients.
Arch Gerontol Geriatr. 2006; 42(2): 225-31.
Healey LA, Sheets PK. The relation of polymyalgia rheumatica to rheumatoid
arthritis. J Rheumatol. 1988; 15(5): 750-2.
Healey LA. Polymyalgia rheumatica and seronegative rheumatoid arthritis may be the
same entity. J Rheumatol. 1992; 19(2): 270-2.
van der Heijde DM, van Riel PL, van Leeuwen MA, van't Hof MA, van Rijswijk MH,
van de Putte LB. Older versus younger onset rheumatoid arthritis: results at onset and
after 2 years of a prospective followup study of early rheumatoid arthritis. J
Rheumatol. 1991; 18(9): 1285-9.
Inoue K, Shichikawa K, Nishioka J, Hirota S. Older age onset rheumatoid arthritis
with or without osteoarthritis. Ann Rheum Dis. 1987; 46(12): 908-11.
Mavragani CP, Moutsopoulos HM. Rheumatoid arthritis in the elderly. Exp Gerontol.
1999; 34(3): 463-71.
Saag KG, Teng GG, Patkar NM, Anuntiyo J, Finney C, Curtis JR, et al. American
College of Rheumatology 2008 recommendations for the use of nonbiologic and
biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis
Rheum. 2008; 59(6): 762-84.
van Schaardenburg D, Lagaay AM, Otten HG, Breedveld FC. The relation between
class-specific serum rheumatoid factors and age in the general population. Br J
Rheumatol. 1993; 32(7): 546-9.
Lopez-Hoyos M, Ruiz de Alegria C, Blanco R, Crespo J, Pena M, RodriguezValverde V, et al. Clinical utility of anti-CCP antibodies in the differential diagnosis
of elderly-onset rheumatoid arthritis and polymyalgia rheumatica. Rheumatology
(Oxford). 2004; 43(5): 655-7.
Sawabe M, Saito M, Naka M, Kasahara I, Saito Y, Arai T, et al. Standard organ
weights among elderly Japanese who died in hospital, including 50 centenarians.
Pathol Int. 2006; 56(6): 315-23.
Lindeman RD, Tobin J, Shock NW. Longitudinal studies on the rate of decline in
renal function with age. J Am Geriatr Soc. 1985; 33(4): 278-85.
10
33.
34.
35.
Shibata H, Haga H, Ueno M, Nagai H, Yasumura S, Koyano W. Longitudinal
changes of serum albumin in elderly people living in the community. Age Ageing.
1991; 20(6): 417-20.
Ishida M, Kuroiwa Y, Yoshida E, Sato M, Krupa D, Henry N, et al. Residual
symptoms and disease burden among patients with rheumatoid arthritis in remission
or low disease activity: a systematic literature review. Mod Rheumatol. 2018; 28(5):
789-799.
Hirano F, Yokoyama W, Yamazaki H, Amano K, Kawakami A, Hayashi T, et al.
Achieving simplified disease activity index remission in patients with active
rheumatoid arthritis is associated with subsequent good functional and structural
outcomes in a real-world clinical setting under a treat-to-target strategy. Mod
Rheumatol. 2017; 27(5): 811-819.
11
Tables
Table 1. Demographic characteristics of patients with elderly-onset rheumatoid arthritis (EORA) and youngonset rheumatoid arthritis (YORA).
EORA
YORA
LDA achievement rate (%)
74.5
77.6
Average age (yrs)
73.8±6.30**
57.8±12.5
Average onset age of RA (yrs)
67.1±6.25
43.1±10.8
Average disease duration (yrs)
6.67±4.76
14.7±11.2**
Female rate (%)
62.9
83.7**
RF positive rate (%)
85.3
80.7
ACPA positive rate (%)
86.5
87.7
SDAI
4.28±3.19
4.59±2.99
DAS28CRP
1.99±0.67
2.04±0.66
Values are given as mean±SD. **p<0.01 was considered to be statistically significant.
Abbreviations: RF, rheumatoid factor; ACPA, anti-citrullinated peptide antibody; SDAI, simplified disease
activity index; DAS28CRP, disease activity score (DAS) 28-CRP
12
Table 2. Medication use in patients with elderly-onset rheumatoid arthritis (EORA) and young-onset rheumatoid
arthritis (YORA).
Table 2a.
EORA
YORA
Rate of PSL use(%)
37.1
36.3
Rate of csDMARDs use (%)
60.0
51.6
Rate of MTX use (%)
55.7
65.3
Rate of Biologics use (%)
32.9**
56.3
Table 2b.
EORA
YORA
At the start of therapy
Current treatment
At the start of therapy
Current treatment
PSL dosage (mg)
1.52±2.28
1.45±2.40
2.22±3.56
1.41±2.88
MTX dosage (mg/w)
3.20±2.92**
2.89±2.98**
5.07±3.13
4.09±3.48
MTX with Biologics
3.92±3.03**
2.92±2.82
5.37±2.94
3.23±2.71
MTX without Biologics
2.83±2.85**
2.04±2.78**
4.63±3.34
5.27±3.09
Values are given as mean±SD. **p<0.01 was considered to be statistically significant.
Abbreviations: PSL, prednisolone; MTX, methotrexate.
13
Table 3. Rheumatoid arthritis-related comorbidities in patients with elderly-onset rheumatoid arthritis (EORA)
and young-onset rheumatoid arthritis (YORA).
Comorbidities, n (%)
EORA
YORA
Interstitial pneumonia
14 (20.0)
21 (11.1)
Hypertension
15 (21.4)**
18 (9.47)
Diabetes
6 (8.57)**
1 (0.53)
Malignant tumor
6 (8.57)
12 (6.32)
Renal insufficiency (with dialysis)
3 (4.29)
6 (3.16)
Stroke
2 (2.86)
3 (1.58)
Hepatitis B
3 (4.29)
5 (2.63)
**P < 0.01 was considered to be statistically significant.
14
Table 4. Biologics used in patients with elderly-onset rheumatoid arthritis (EORA) and young-onset rheumatoid
arthritis (YORA).
EORA
Drug name of Biologic, n (%)
YORA
At the start of
therapy
Current treatment
At the start of
therapy
Current treatment
Infliximab
3 (11.1)
4 (17.4)
15 (13.3)
16 (15.2)
Etanercept
13 (48.1)
8 (34.8)
50 (44.2)
38 (36.2)
Adalimumab
2 (7.40)
1 (4.35)
9 (7.96)
6 (5.71)
Golimumab
2 (7.40)
1 (4.35)
6 (5.30)
5 (4.76)
Certolizumab pegol
0 (0)
2 (8.69)**
4 (3.53)
2 (1.91)
Tocilizumab
4 (14.8)
2 (8.69)
18 (15.9)
29 (27.6)**
Abatacept
3 (11.1)
5 (21.3)**
11 (9.73)
9 (8.57)
Total
27 (100)
23 (100)
113 (100)
105 (100)
**p<0.01 was considered to be statistically significant.
15
Table 5. Conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) used in patients with
elderly-onset rheumatoid arthritis (EORA) and young-onset rheumatoid arthritis (YORA).
Drug name of csDMARDs, n (%)
EORA
YORA
Salazosulfapyridine
26 (57.8)
59 (49.1)
Bucillamine
2 (4.44)
6 (5)
Iguratimod
2 (4.44)
17 (14.2)**
Tacrolimus
15 (33.3)
36 (30.0)
Leflunomide
0 (0)
2 (1.67)
Total
45 (100)
120 (100)
**p<0.01 was considered to be statistically significant.
16
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