Session Title: Rheumatoid Arthritis - Clinical Aspects III: Infections/Risk Factors for Incident Rheumatoid Arthritis/Metrology/Classification/Biomarkers/Predictors of Rheumatolid Arthritis Activity & Severity
Session Type: Abstract Submissions (ACR)
Mortality is increased in rheumatoid arthritis (RA). Contributing factors are disease activity/severity and comorbidity. A relationship between age at onset and pharmacological treatment has been implicated. We evaluated the impact of age at onset on prognostic risk factors and given treatment during five years from disease onset.
All patients from the 4 most northern counties of Sweden diagnosed with RA (<12 months symptoms) are consecutively included in a large survey on the progress of the disease and its co-morbidies. Up till now 950 (649f, 301m) patients have been included. Median age at disease onset was 58 years (range 18-89). All patients have been followed on a regular basis; a survey of co-morbidities was made at inclusion and after 5 years, measures of disease activity (ESR, CRP, tender joints, swollen joints, VAS pain and VAS global, DAS28, HAQ) and X-ray of hands (erosions, Larsen score) were assessed regularly. Disease severity (extraarticular disease, rheumatoid nodules), co-morbidities and pharmacological treatment (DMARDs, corticosteroids, biologics, NSAIDs, COX2-inhibitors) were registered. Autoantibodies (RF, ANA, ACPAs) and genetic markers (HLA-shared epitope, PTPN22 T-variant) were analysed. Young (YORA)/late (LORA) onset of RA was defined as below/above median age (58 years) at disease onset. Data analyses were based on stratification of the patients in YORA and LORA.
Patients with LORA had higher ESR (34.3 vs. 26.0 mm/h, p<0.001), VAS global (47.8 vs. 42.9, p=0.085) and HAQ (1.0 vs 0.8, p=0.075) at baseline and significantly higher accumulated disease activity (AUC for DAS28) at 6 (p=10.0), 12 (p<0.01) and 24 months (p<0.05) compared to YORA. Patients with YORA had more often ACPAs (72.4% vs 65%; p<0.01) and PTPN22 T-variant (37,8 vs 29.5, p=0.056). Presence of extraarticular disease was similar however nodules tended to be more common at young onset (p=0.069) and YORA had significantly higher Larsen score (p<0.001 at 0 and 24 mo). Patients with LORA were significantly more often treated with corticosteroids (77.5 vs. 68.8%; p<0.01), significantly less with methotrexate (81.9 vs. 90.2%; p<0.01) and with biologics (7.6 vs. 24.9%, <0.001). Patients with YORA were treated with DMARDs earlier (within 3 months from inclusion; 94.0% vs. 85.8%; p<0.01) and overall (98.9 vs. 96.7, p=0.05). NSAID was more common in the early onset group (90 vs. 75.9%, p<0.001) with no difference for COX2 inhibitors.
Patients with young onset of RA presented with more risk factors for poor prognosis but those with late onset had higher disease activity. YORA were treated with more DMARDs in early disease whilst those with LORA were treated more often with corticosteroids. This may have implications for development of co-morbidities.
E. H. Berglin,
S. M. Rantapää-Dahlqvist,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/age-at-onset-determines-severity-and-choice-of-treatment-in-early-rheumatoid-arthritis/