Late onset-disease was associated with less frequent treatment with methotrexate and biologics compared with YORA, as well as with less frequent treatment with DMARDs early in the disease process, that is , within 3 months from inclusion into the study. Apparently, treatment with corticosteroids reduced inflammatory activity efficiently but could not compensate for the less frequent DMARD treatment early in the disease course in the patients with late-onset disease in terms of radiological status at 24 months.
Radiological progression appeared without regard to the chosen drug treatment. It is conceivable that a more evident impact of the chosen treatment would be demonstrable in a larger cohort or with a longer follow-up period. There was no delay in the diagnosis of the LORA patients, with the disease duration being somewhat shorter in this group. Coexisting osteoarthritis could contribute to the worse radiographic status in LORA patients, as could the possibility of cartilage that is more susceptible to damage in elderly individuals, as has been suggested by others [ 11 , 14 ].
However, our finding of a greater Larsen score cannot be explained simply by the progression of cartilage damage as part of osteoarthritis, because there was also a significant progression of the erosions over time in LORA patients. Thus, the treatment of LORA patients with corticosteroids did not reduce radiological progression, despite the positive effects of these drugs on inflammatory activity.
Treatment with low doses of prednisolone as a monotherapy, or in combination with DMARDs, has previously been reported to have positive effects with respect to the remission rate and inhibition of radiographic progression [ 46 — 48 ]. However, contrasting results were reported by Paulus et al.
Earlier studies generally concluded LORA to be a mild disease with a good prognosis [ 16 — 19 ] but several more recent studies have shown equal, or worse, disease activity and severity in older patients compared with younger patients [ 11 — 15 , 22 , 50 ]. Nevertheless, our study shows that age at disease onset influences the choice of pharmacological treatment.
Anderson et al. One possible explanation for later initiation of DMARD treatment is that LORA patients tend to have more comorbidities and coexisting diseases requiring treatment with other drugs. However, when comorbidity at baseline was also taken into account, the choice of treatment was associated with age at onset of disease. Early in the disease course, it is easy and efficient to control disease activity by using corticosteroid treatment.
Both the clinician and the patient may be pleased with the rapid relief of symptoms achieved with corticosteroid treatment, and there is more concern about the potential side effects of DMARDs in older patients. At times, this clinical decision may be correct, and a risk vs. Treatment with corticosteroids can be precarious in elderly patients and should be evaluated with respect to increased risk of adverse effects, such as osteoporosis, infection, diabetes, peptic ulcers , cataract and HT [ 52 ].
In the current literature, data are still lacking regarding the net effect of corticosteroids in patients with inflammation. Several studies have shown that treatment with methotrexate, sulphasalazine and antimalarial therapy, and other DMARDs is well-tolerated by the elderly [ 50 ]. Tutuncu and co-workers showed that toxicity due to methotrexate and biological agents was very low in all patients studied, regardless of age [ 13 ]. This observation is consistent with recently published findings of Huscher et al.
Recent studies have shown that biological therapy can be used in the treatment of elderly patients, but risk factors for adverse effects should be evaluated extra carefully before starting any therapy [ 54 , 55 ]. The strengths of the present study are the patient group, which consists of a large regional cohort, and its prospective design. The study involves few physicians at each rheumatology centre in northern Sweden.
In Sweden, essentially all patients with newly diagnosed RA are referred to a specialist. Thus, the results derived from the present cohort can be regarded as applicable to all patients with early RA. Furthermore, repeated measurement of the parameters associated with inflammation made it possible to take into account variability in disease activity. Conversely, a limitation of the study is its observational nature, with a risk of confounding by indication when evaluating the efficiency of pharmacological treatment.
We attempted to adjust for that possibility by using multiple regression modelling in the statistical analyses when evaluating potential covariates in relation to LORA. LORA was associated with greater incipient disease activity, reduced function at baseline and more radiological damage at disease onset and over time.
We propose that patients with LORA should receive the same treatment as younger patients at the onset of disease; however, such patients may require tighter controls to rapidly detect any potential complicating comorbidity or other undesirable side effects of the treatment.
Arthritis Rheum. Article PubMed Google Scholar. Ann Intern Med. J Rheumatol. Clin Exp Rheumatol. Best Pract Res Clin Rheumatol. Ann Rheum Dis. A prospective study of outcome and prognostic factors. Rheumatology Oxford. Clin Rheumatol. Article Google Scholar. Oka M, Kytila J: Rheumatoid arthritis with the onset in old age.
Acta Rheumatol Scand. Adler E: Rheumatoid arthritis in old age. Isr J Med Sci. Br Med J. PubMed Google Scholar. Google Scholar. Arthritis Care Res Hoboken. Am J Med. O'Dell JR: Therapeutic strategies for rheumatoid arthritis. N Engl J Med. Scand J Rheumatol.
Arthritis Res Ther. Here, find out more. Rheumatoid arthritis mainly causes pain in the joints, but it can also affect many other areas. Here, learn about the varied and long-term effects of…. Arthritis is a term that describes around conditions that cause pain in the joints and the tissues surrounding the joints. The most common form of…. When a person has a rheumatoid arthritis RA flare, their symptoms will worsen for a while.
Here, get some tips on how to manage symptoms of RA…. Research into rheumatoid arthritis RA treatment is ever-evolving. Here, two rheumatology experts discuss the latest options, plus what is on the…. What is the age of onset for rheumatoid arthritis? Medically reviewed by Nancy Carteron, M.
Common onset age Why it matters In adults In older adults In children and teenagers Contacting a doctor Summary Rheumatoid arthritis RA is an inflammatory disorder affecting the joints. What is the most common age of RA onset? Why does the onset age matter? RA onset in adults. RA onset in older adults. Juvenile idiopathic arthritis. When to speak with a doctor. Exposure to air pollutants may amplify risk for depression in healthy individuals.
Costs associated with obesity may account for 3. Researchers have been trying to find out why. The reproductive hormones estrogen and progesterone seem to potentially have a protective effect against symptoms of RA.
Factors that can affect these levels include:. An older study on a small group of middle-aged women with RA found that they reported fewer joint symptoms during post-ovulation in their menstrual cycles and also during pregnancy. This is when levels of estrogen and progesterone are higher. Medical experts tend to agree that the effect of sex hormones combined with environmental and genetic factors could explain the higher prevalence of women diagnosed with RA. According to the CDC , the diagnoses in the United States of all types of arthritis from to are as follows:.
During the same years, 26 percent of women and Prevalence of the disease increases with age, nearing 5 percent in women over age 55 years. Recurrent bouts of fatigue along with a general sense of not feeling well may occur weeks or months before other symptoms. Joint stiffness usually lasts anywhere from 1 to 2 hours and sometimes longer. It can also occur after prolonged periods of rest or inactivity such as napping or watching television.
Stiffness and decreased range of motion can eventually make simple daily tasks such as buttoning a shirt or opening a jar difficult. When the disease is active, affected joints become red, swollen, painful, and feel warm to the touch. In the early stages of RA, smaller joints in the hands, wrists, and feet tend to be affected first. Over time, larger joints in the knees, shoulders, hips, and elbows may become affected. What differentiates RA from other types of arthritis is that RA symptoms attack symmetrically.
This means that if your left wrist is inflamed, your right wrist likely will be inflamed as well. According to the Johns Hopkins Arthritis Center , 20 to 30 percent of people with RA develop rheumatoid nodules, firm lumps of tissue that grow under the skin at bony pressure points.
Rheumatoid nodules are most often found on elbows, but they can be found on other areas of the body, such as on the fingers, over the spine, or on the heels. Chronic inflammation caused by RA over the long term may cause damage to bone, cartilage, tendons, and ligaments. In advanced stages, RA can lead to extensive bone erosion and joint deformity. A telltale sign of severe RA is twisted fingers and toes bent at unnatural angles.
0コメント