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Background <p>Elderly-onset rheumatoid arthritis (EORA) may have peculiar findings compared to juvenile-onset RA (JORA). The aim of the work was to present and compare the clinical characteristics of RA patients with JORA and elderly-onset EORA to a group of cases with adult-onset (AORA) and to contrast the findings worldwide.</p> Methods <p>The study included 1100 adult RA patients: 209 JORA and 329 EORA, compared with 562 AORA extracted from a big data national study on 10,364 RA patients. Clinical characteristics, laboratory investigations, medications received, and co-morbidities were recorded. The disease activity index (DAS28) and health assessment questionnaire (HAQ) were estimated.</p> Results <p>The JORA cases represented 19% and EORA 29.9% of the included cohort. The mean age at onset for JORA, EORA, and AORA were 15.1 ± 2.1, 64 ± 4.2, and 36.4 ± 10&#xa0;years (<i>p</i> &lt; 0.0001), and the female-male ratio was 6.2:1, 2.7:1, and 7.3:1 (<i>p</i> &lt; 0.0001), respectively. In EORA, body mass index (28.8 ± 5.8) and frequencies of smokers (11.6%), diabetes (12.2%), hypertension (19.8%), and osteoporosis (5.2%) were significantly higher than in JORA (26.02 ± 5; 5.3%, 2.9%, 3.8%, and 1%) and AORA (27.6 ± 5.6; 3%, 8.4%, 14.9%, and 2.3%, <i>p</i> = 0.016) (<i>p</i> &lt; 0.0001, <i>p</i> = 0.001, <i>p</i> &lt; 0.0001, and <i>p</i> = 0.009, respectively). In JORA, oral ulcers were significantly more frequent (<i>p</i> = 0.04); in EORA, cardiovascular manifestations (<i>p</i> &lt; 0.0001) and hypothyroidism (<i>p</i> = 0.039) were more frequent; and DAS28 (<i>p</i> = 0.01) and HAQ (<i>p</i> = 0.038) were higher. Fibromyalgia and methotrexate administration were significantly more frequent in AORA (<i>p</i> &lt; 0.0001 and <i>p</i> = 0.04, respectively). Rheumatoid factor, anti-cyclic citrullinated peptide, and double seropositivity were significantly more frequent in EORA (<i>p</i> &lt; 0.0001, <i>p</i> = 0.008, and <i>p</i> = 0.002, respectively).</p> Conclusion <p>Comorbidities, cardiovascular manifestations, hypothyroidism, higher disease activity, and functional disability are more common in EORA patients.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> <p><b>Key Points</b></p> <p>•<i>&#xa0;Juvenile-onset and elderly-onset RA patients have notable differences compared to the adult-onset cases.</i></p> <p>•<i>&#xa0;Co-morbidities and certain manifestations, including cardiovascular disease and hypothyroidism, as well as higher disease activity and functional disability, are more common in elderly-onset patients.</i></p> <p>•<i>&#xa0;Fibromyalgia remains more frequent in adult-onset cases.</i></p> </entry> </row> </tbody> </tgroup> </Table></p>

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International overview on juvenile-, adult- and elderly-onset rheumatoid arthritis: The age at disease onset as a fundamental determinant of clinical presentation

  • 期刊论文

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  • 发表日期：

    2025年2月6日

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  • Nevin Hammam,
  • Tahsin El-Hadidi,
  • Khaled El-Hadidi,
  • Ahmed Elsaman,
  • Samah A. El-Bakry,
  • Maha Nassr,
  • Hanan M. El-Saadany,
  • Doaa Mosad,
  • Samah I. Nasef,
  • Zahraa I. Selim,
  • Nermeen Samy,
  • Abdelhfeez Moshrif,
  • Hanan Taha,
  • Rasha M. Fawzy,
  • Suzan S. Al-Adle,
  • Amira M. Ibrahim,
  • Nora Y. Elsaid,
  • Samar Tharwat,
  • Nada M. Gamal,
  • Maha E. Ibrahim,
  • Soha Senara,
  • Rawhya El Shereef,
  • Marwa A. Amer,
  • Faten Ismail,
  • Mervat I Abd Elazeem,
  • Nouran M. Abaza,
  • Eman F. Mohamed,
  • Dina F. El-Essawi,
  • Saad M. Elzokm,
  • Samar M. Fawzy,
  • Nahla N. Eesa,
  • Enas A. Abdelaleem,
  • Ahmed M. Abdalla,
  • Hanan M. Fathi,
  • Hatem H. El-Eishi,
  • Safaa Sayed,
  • Reem Hamdy A. Mohammed,
  • Tamer A. Gheita

摘要

Background

Elderly-onset rheumatoid arthritis (EORA) may have peculiar findings compared to juvenile-onset RA (JORA). The aim of the work was to present and compare the clinical characteristics of RA patients with JORA and elderly-onset EORA to a group of cases with adult-onset (AORA) and to contrast the findings worldwide.

Methods

The study included 1100 adult RA patients: 209 JORA and 329 EORA, compared with 562 AORA extracted from a big data national study on 10,364 RA patients. Clinical characteristics, laboratory investigations, medications received, and co-morbidities were recorded. The disease activity index (DAS28) and health assessment questionnaire (HAQ) were estimated.

Results

The JORA cases represented 19% and EORA 29.9% of the included cohort. The mean age at onset for JORA, EORA, and AORA were 15.1 ± 2.1, 64 ± 4.2, and 36.4 ± 10 years (p < 0.0001), and the female-male ratio was 6.2:1, 2.7:1, and 7.3:1 (p < 0.0001), respectively. In EORA, body mass index (28.8 ± 5.8) and frequencies of smokers (11.6%), diabetes (12.2%), hypertension (19.8%), and osteoporosis (5.2%) were significantly higher than in JORA (26.02 ± 5; 5.3%, 2.9%, 3.8%, and 1%) and AORA (27.6 ± 5.6; 3%, 8.4%, 14.9%, and 2.3%, p = 0.016) (p < 0.0001, p = 0.001, p < 0.0001, and p = 0.009, respectively). In JORA, oral ulcers were significantly more frequent (p = 0.04); in EORA, cardiovascular manifestations (p < 0.0001) and hypothyroidism (p = 0.039) were more frequent; and DAS28 (p = 0.01) and HAQ (p = 0.038) were higher. Fibromyalgia and methotrexate administration were significantly more frequent in AORA (p < 0.0001 and p = 0.04, respectively). Rheumatoid factor, anti-cyclic citrullinated peptide, and double seropositivity were significantly more frequent in EORA (p < 0.0001, p = 0.008, and p = 0.002, respectively).

Conclusion

Comorbidities, cardiovascular manifestations, hypothyroidism, higher disease activity, and functional disability are more common in EORA patients.

Key Points

• Juvenile-onset and elderly-onset RA patients have notable differences compared to the adult-onset cases.

• Co-morbidities and certain manifestations, including cardiovascular disease and hypothyroidism, as well as higher disease activity and functional disability, are more common in elderly-onset patients.

• Fibromyalgia remains more frequent in adult-onset cases.