Higher risk of poor functional outcome and unfavorable clinical events for late-onset rheumatoid arthritis: results from the IORRA cohort

Naohiro Sugitani; Eiichi Tanaka; Eisuke Inoue; Mai Abe; Eri Sugano; Kumiko Saka; Moeko Ochiai; Rei Yamaguchi; Katsunori Ikari; Hisashi Yamanaka; Masayoshi Harigai

doi:10.1093/rheumatology/keae673

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. Online ahead of print.

Authors

Naohiro Sugitani¹, Eiichi Tanaka¹, Eisuke Inoue^{1

2}, Mai Abe¹, Eri Sugano¹, Kumiko Saka¹, Moeko Ochiai¹, Rei Yamaguchi¹, Katsunori Ikari³, Hisashi Yamanaka^{4

5}, Masayoshi Harigai¹

Affiliations

¹ Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
² Showa University Research Administration Center, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
³ Section of Surgery for Inflammatory Joint Diseases, Department of Orthopedic Surgery, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666, Japan.
⁴ Rheumatology, Sanno Medical Center, 8-5-35 Akasaka, Minato-ku, Tokyo, 107-0052, Japan.
⁵ Department of Rheumatology, International University of Health and Welfare, 4-3 Kozunomori, Narita City, Chiba, 286-8686, Japan.

PMID: 39680892
DOI: 10.1093/rheumatology/keae673

Abstract

Objectives: To compare treatment outcomes in patients with late-onset rheumatoid arthritis (LORA) and younger-onset rheumatoid arthritis (YORA).

Methods: We analyzed patients diagnosed with early rheumatoid arthritis (disease duration < 2 years) between 2000 and 2016 in the IORRA cohort. Patients were categorized into LORA (onset at ≥ 65 years) and YORA (onset at < 65 years). The primary outcomes were changes in Clinical Disease Activity Index (CDAI) and Japanese version of the Health Assessment Questionnaire (J-HAQ) at Year 5. The secondary outcomes included the incidence of prespecified adverse events.

Results: Methotrexate, biological disease-modifying anti-rheumatic drugs, and glucocorticoids were used in 70.6%, 8.4%, and 38.0% of the LORA group (n = 813, median age: 71 years), and 81.6%, 19.4%, and 32.0% of the YORA group (n = 2,457, median age: 51 years). Both groups exhibited significant initial improvements in CDAI and J-HAQ scores. At Year 5, mean CDAI scores were 4.39 and 4.03 for the LORA and YORA groups, respectively. J-HAQ score for YORA remained stable below 0.5 after Year 2, whereas that for LORA worsened progressively. At Year 5, mean J-HAQ scores were 0.56 for LORA and 0.33 for YORA. Patients with LORA had a higher incidence of adverse events, with adjusted hazard ratios of 4.70 for death and 2.58 for malignancy.

Conclusions: Patients with LORA and YORA exhibited similar improvements in disease activity over 5 years; however, those with LORA demonstrated a more pronounced decline in physical function.

Keywords: Clinical Disease Activity Index; Japanese version of the Health Assessment Questionnaire; Late-onset rheumatoid arthritis; adverse events; cohort study.