Background/Purpose:

Rheumatoid arthritis (RA) is a chronic disease with peak incidence in the fourth and fifth decades of age. To investigate whether age at disease onset determines clinical, radiographic or functional outcomes in a cohort of early RA, taking into consideration possible age-related differences in treatment modalities. 

Methods:

The ESPOIR cohort is a longitudinal, prospective, multicenter, observational study of adult patients with early arthritis. For this study, we selected data for patients fulfilling the 2010 American College of Rheumatology/European League Against Rheumatism criteria for RA during the first 3 years of follow-up. Patients were pooled into 3 groups by age at RA onset: <45 years (young-onset RA [YORA]), 45 to 60 years (intermediate-onset RA [IORA]) and >60 years (late-onset RA [LORA]). The following outcomes were compared at baseline and during the first 3 years of follow-up by age at disease onset: Simple Disease Activity Index (SDAI) remission rate, one additional erosion, and Health Assessment Questionnaire Disability Index (HAQ-DI) score < 0.5. We also assessed first disease-modifying anti-rheumatic drug (DMARD) survival rate. A multivariate model (logistic regression) was built.

Results:

We included 698 RA patients (median [interquartile range] age 50.3 [39.8-57.2] years; female 78.2%), 266 YORA, 314 IORA, and 118 LORA. The median SDAI was 28.5 (20.6-38.6) and median HAQ-DI score 1 (0.5-1.5). At 1 year, SDAI remission was greater for patients with YORA than IORA and LORA (<0.0001). Having at least one additional erosion was greater for LORA and IORA than YORA patients after 1 year (41.1% [39/95] and 29.7% [81/272] vs 23.8% [51/214], p=0.009) and 3 years (48.2% [41/85] and 44.3% [105/237] vs 32.81% [63/192], p=0.017). The proportion of patients with HAQ score < 0.5 was greater for YORA than IORA and LORA at 1 year (p=0.007) and remained significant at 2 and 3 years. The first DMARD survival rate was lower for YORA than IORA and LORA patients during the 3 years (p=0.005). On multivariate analysis, young age at RA onset was independently associated with SDAI remission at 1 year, no additional erosion at 3 years and HAQ score < 0.5 at 1, 2 and 3 years.

Conclusion:

In a cohort of early RA, young age at disease onset is associated with high rate of remission at 1 year, low radiographic progression at 3 years and low functional score during 3-year follow-up. Young age at disease onset is associated with low first DMARD survival rate over 3 years, which suggests that late-onset RA patients may receive less aggressive treatment strategies than younger patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-age-at-rheumatoid-arthritis-onset-on-clinical-radiographic-and-functional-outcomes-the-espoir-cohort/