Background/Purpose:

The aim of this study was to evaluate three year outcomes of patients with elderly-onset RA (EORA) who were treated with a therapeutic strategy targeting low disease activity (LDA), and clinical factors associated with physical dysfunction in patients who achieved LDA.

Methods:

Data of 197 MTX-naïve EORA (mean age 74.9) from a prospective, monocentric registry were analyzed. Treatment was adjusted targeting LDA defined by DAS28-ESR or simplified disease activity index (SDAI). Treatment was initiated with non-biologic DMARDs (nbDMARDs), followed by biologic DMARDs such as TNF inhibitors, tocilizumab, or abatacept. Primary outcomes were obtained from SDAI and the HAQ disability index (HAQ-DI). Serious adverse events (SAEs) during three years of observational period were assessed at all visits. Associated factors of physical dysfunction (HAQ-DI >0.5) in patients who achieved SDAI-LDA at week 156 or at dropout were examined using multivariate logistic regression models.

Results:

MTX was administered in 167 (85%) of the 197 patients, and dose-dependent adverse drug reactions were observed in 100 patients, and 158 patients received mean 8.5 mg/week of MTX at week 24, and 35% of them received a biologic DMARD with or without MTX at week 52, 36% at week 104, and 33% at week 156. Median dose of 3.5mg/day of prednisolone (PSL) were administered with DMARDs in 17% of the patients at week 156. Adherence to the treat-to-target (T2T) strategy was observed in 81%, 87%, 91% at week 24, 52, and 104 weeks, respectively. At week 56, 104, and 156, SDAI-LDA was achieved in 73%, 82%, and 88% by last observation carried forward analysis, SDAI-remission in 36%, 50%, and 56%, and HAQ-DI ≤0.5 in 68%, 71%, and 72%, respectively. Clinically relevant radiological progression (CRRP: Δ modified total sharp score [mTSS] /year >the smallest detectable change [2.1]) was observed in 28% at week 52. Infection requiring hospitalization occurred in 31 patients during the observational period, extra-articular manifestations in 13, ischemic heart disease in 9, malignancy in 11, and bone fracture in 20. Twenty-nine (15%) of the 197 patients dropped from the study for aging (dementia or sarcopenia) in 11, patient decision in 6, exacerbation of interstitial lung disease in 5, infection in 4, malignancy in 2, and sudden death in 1, and 18 of the 29 patients achieved LDA at dropout. HAQ-DI ≤0.5 was not achieved in 46 of the 173 patients who achieved LDA at week 156 or at dropout. Multivariate analysis showed older age (odds ratio (OR) 1.15, 95% confidence interval (CI) 1.07-1.23), SAEs occurred during the observational period (OR 3.96, 95%CI 1.76-8.92), and higher SDAI (OR 1.16, 95%CI 1.02-1.33) were significantly associated with risk of non-achievement of HAQ-DI ≤0.5 in patients who achieved SDAI-LDA. Comorbidities at baseline, mTSS at baseline, and CRRP at week 52 were not significant. Infection requiring hospitalization, ischemic heart disease, and bone fracture were significant among the SAEs.

Conclusion:

The patients with EORA can achieve clinical remission and normal physical function by therapeutic strategy targeting LDA. SAEs under T2T strategy of EORA have great impact on physical dysfunction in patients who achieved treatment goals.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/three-year-outcomes-of-patients-with-elderly-onset-rheumatoid-arthritis-treated-with-a-therapeutic-strategy-targeting-low-disease-activity-and-impact-of-adverse-events-on-physical-function/