Background/Purpose:  In daily practice, our rheumatologist has experienced different clinical feature of elderly-onset rheumatoid arthritis (EORA) compared with younger-onset RA (YORA). In EORA patients, serological marker of inflammation, like C-reactive protein, tend to be higher than that of YORA. And previous report suggested that significantly higher level of serum interleukin-6 (IL-6) and lower level of serum of tumor necrosis factor -α were detected in EORA compared with YORA patients. Hence, in elderly patients, IL-6 might be more important for the pathogenesis of RA. However, the treatment for EORA remains uncertain. We hypothesize that anti-IL-6 therapy is more effective for EORA patients than YORA patients. The objective this study is to clarify that the efficacy of anti -IL-6 therapy to EORA patients.

Methods: Inclusion criteria were as follows: diagnosis of RA based on 2010 ACR/EULAR classification criteria; the patients treated by anti-IL-6 drugs (tocilizumab or sarilumab); the disease activity could be evaluated at baseline and week 24 from started anti-IL-6 treatments by using disease activity score 28 erythrocyte sedimentation rate (3) (DAS28-ESR (3)). These patients were classified 3 groups according to RA onset age; younger-onset(YO); under 60 years old), middle age onset (MO); 60-69 years old, and elderly-onset (EO); equal or over 70 years old). And we compared the baseline characteristics, disease activity between 3 groups.

Results: We examine 107 RA patients who treated with anti-IL-6 drugs. Sixty-seven patients were YO, 22 were MO, 18 were EO. The rate of female patients was higher in YO compared with EO (92.5% vs 66.7%). Disease duration tends to be longer according to age at disease onset (EO; 11.7 years, MO; 5.5 years, YO; 1.4 years, respectively). And rate of seronegative (rheumatoid factor and anti-cyclic citrullinated peptides antibodies were negative) patients were also higher in EO compared with the other groups. The mean change of DAS28-ESR(3) from baseline to week 24 was significantly greater with EO than MO or YO(p < 0.05). In analysis of each component of DAS28-ESR (3), tenderness joint count and swollen joint count was tended to decrease in EO. However, only ESR was significantly decreased in EO (< 0.05).

Conclusion: In EORA patients, anit-IL-6 therapy could be more effective than YORA patients. And especially, ESR of EORA patients could be more decreased by anti-IL-6 therapy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effectiveness-of-anti-il-6-therapy-to-elderly-onset-rheumatoid-arthritis/