Background/Purpose: Comparison of frequency of different clinical features of the natural course at the stage of early rheumatoid arthritis (RA) in patients with young and older age are not sufficiently covered in the literature.

Comparative study of early RA with onset at young (18-49 years) and older age (50 years and older) before start of DMARDs, biologics and other targeted therapy and glucocorticoids.

Methods: 292 patients with RA were included into the All-Russian register of patients with arthritis “OREL” in the period from January 01, 2012 to December 31, 2018 with research data at the time of the first visit. All patients did not receive DMARDs (synthetic, biological or other targeted drugs) and glucocorticoid systemic therapy before being entered into the registry and were investigated before prescribing DMARDs. 141/292 patients (25 men, 116 women, mean age 39.27 ± 7.97 years, mean duration of disease 5,7±2,75 months) had RA onset at a younger (18-49 years old) age – group 1, 151/292 (men – 41, women – 110, mean age 66.05 ± 7.34 years, mean duration of disease 4,3±3,6 months) had RA onset at senior age (50 years and older) – group 2. RA was diagnosed in accordance with 1987 ACR and 2010 ACR/EULAR criteria. Disease activity was assessed according to DAS-28 index, X-ray stage – according to Steinbrocker, modified stages, functional disorders – in accordance with functional class (FC).

Results: In the group 2, the male / female ratio was higher (1: 2.8) than in the group 1 (1: 4.6) (p=0,055), which indicates a tendency to equalization of the sex ratio with age. Following disorders developed more often in group 2 than group 1: restriction of mobility and morning stiffness (82% vs 59%) (p< 0.05), the frequency of damage to small joints of the hands (76% vs 65%) (p >0.05), wrists (65% vs 52%) (p< 0.05), elbow (33% vs 17%) (p< 0.05), knee (53% vs 36%) (p< 0.05), shoulder (44% vs 19%) (p< 0.05), the total number of affected joints also significantly prevailed in the group 2 (in total cases p< 0,05). Group 2 patients showed stronger and more frequently inflammatory process patients of group 2 comparatively with the Group 1 was (high inflammatory activity - 66% versus 35%, respectively) (p< 0.05), as well as destructive changes (erosive arthritis - 52% versus 29%; p< 0.05) in the joints and functional disorders (FC 3 - 68% versus 15%, respectively) (p< 0.05). Extra-articular manifestations in the form of rheumatoid nodules were more often recorded in the group 2 (10% versus 2%) (p< 0.05). At the same time, ACPAs was not significantly more often detected in group 1 (89% versus 78%) (p > 0.05) with the common frequency of RF detection (72% and 72%).

Conclusion: Comparative study of the clinical characteristics of the natural course of early RA with onset in young adult (18-49 years) and with onset in older (50 years and older) age according to the data of the All-Russian register of patients with arthritis OREL showed that RA with onset in older age is characterized by stronger and more frequently inflammatory process, destructive and functional disorders in the joints than RA with onset at a younger age.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparative-characteristics-of-the-natural-course-of-early-rheumatoid-arthritis-with-onset-at-a-young-age-18-49-years-and-older-50-years-and-older-patients-who-did-not-take-dmards-biologics-othe/