POS0662 COMPARISON OF DISEASE ACTIVITY AND TREATMENT APPROACHES DURING THE EARLY STAGES OF ONSET BETWEEN LATE-ONSET RHEUMATOID ARTHRITIS AND YOUNGER-ONSET RHEUMATOID ARTHRITIS

• Published in: Annals of the rheumatic diseases Vol. 83; no. Suppl 1; p. 809
• Main Authors: Matsui, T., Yoshida, T., Nishino, T., Tohma, S.
• Format: Journal Article
• Language: English
• Published: Kidlington BMJ Publishing Group Ltd and European League Against Rheumatism 01.06.2024; Elsevier B.V; Elsevier Limited
• Subjects: Age; biological DMARD; Citrulline; Disease; Disease-modifying Drugs (DMARDs); Glomerular filtration rate; Glucocorticoids; Nonsteroidal anti-inflammatory drugs; Observational studies/ registry; Patients; Real-world evidence; Remission; Remission (Medicine); Rheumatoid arthritis; Rheumatoid factor; Scientific Abstracts; TNF inhibitors; Japan; Disease-modifying Drugs (DMARDs); Observational studies/ registry; Glucocorticoids; biological DMARD; Real-world evidence
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2024-eular.2911

Background:In recent years, the number of patients with late-onset rheumatoid arthritis (LORA) has been increasing [1]. LORA patients are often subject to various treatment restrictions due to their advanced age from the time of onset, and it has been reported that rheumatologists tend to hesitate to treat older patients aggressively [2]. However, no treatment strategy or treatment recommendation that takes age of onset into consideration has been proposed. Furthermore, it is suggested that there is diversity within LORA due to differences in the age of onset.Objectives:To compare the patient attributes, treatment approach and disease activity during the early stages of onset between late-onset rheumatoid arthritis (LORA) and younger-onset rheumatoid arthritis (YORA), and to clarify the differences between younger-onset LORA (“early LORA”) and older-onset LORA (“late LORA”).Methods:Among the 17,181 patients registered in NinJa (National Database of Rheumatic Diseases in Japan) [3], a nationwide RA database in Japan) in 2021, 1,154 patients with onset of disease less than 2 years were extracted. They were divided into three groups based on the age of onset: those under 65 years old in the YORA group (491 cases), those between 65 and 74 years old in the early LORA group (336 cases), and those over 75 years old in the late LORA group (327 cases). Their characteristics, disease activity, remission rates, and drugs used were compared.Results:The ages (mean [SD]) of the YORA, early LORA, and late LORA groups were 51.4 [10.3] years, 70.4 [2.8] years, and 81.1 [3.9] years. The proportion of men (24.2% in YORA, 37.8% in early LORA, and 33.0% in late LORA) was higher in LORA groups than in YORA, with BMI (22.8 [4.2], 22.9 [3.5], 22.2 [2.9]) and current plus past smoking rate (47.8 %, 48.7%, 33.0%) were significantly lower in late LORA. The mean estimated glomerular filtration rate (mL/min/1.73m2) (80.3 [16.0], 71.5 [16.0], 61.0 [17.7]), rheumatoid factor positive rate (69.3%, 61.5%, 58.8%) and anti-cyclic citrullinated peptide antibody positive rate (71.1%, 57.0%, 50.0%) showed a significant difference between YORA and LORA groups. No significant difference was observed in the mean values of DAS28-ESR (2.84 [1.27], 3.06 [1.37], 3.04 [1.23]) and CDAI (7.10 [7.44], 7.43 [8.60], 6.23 [7.30]). The remission rate evaluated by DAS28-ESR (2.84 [1.27], 3.06 [1.37], 3.04 [1.23]) was not different among groups, but that by CDAI (35.0%, 37.8%, 44.3%) was significantly higher in late LORA than in YORA. MTX usage rate (76.4%, 66.8%, 58.7%), any csDMARDs usage rate other than MTX (39.9%, 43.0%, 55.5%), corticosteroid usage rate (31.2%, 40.8%, 47.0%), and NSAIDs usage rate (41.1%, 38.6%, 29.3%) showed significant differences between groups. No significant difference was observed in total biologics usage (12.6%, 11.7%, 11.3%), non-TNF inhibitors usage (5.5%, 7.0%, 8.5%), and JAK inhibitors usage (3.4%, 4.4%, 6.0%), however, there was a significant difference in the TNF inhibitors usage (7.1%, 4.7%, 2.8%) and the selection rate of non-TNF inhibitors among biologics users (43.6%, 59.5%, 75.0%).Conclusion:During the early stage of disease onset, LORA achieved disease activity control equivalent to that of YORA, but the treatment content differed significantly. Furthermore, differences were observed in patient attributes and treatment content between early LORA and late LORA, clarifying that there is also diversity within LORA.REFERENCES:[1] Int J Rheum Dis. 2017; 20:839-45.[2] J Rheumatol. 2018; 45:590-594.[3] Expert Rev Clin Immunol. 2012; 8:455-65.Acknowledgements:NIL.Disclosure of Interests:Toshihiro Matsui AbbVie, AsahiKASEI, Astellas, Chugai, Eisai, Eli Lilly, Ono, Pfizer, AsahiKASEI, Chugai, Tomoya Yoshida: None declared, Takahiro Nishino: None declared, Shigeto Tohma AsahiKASEI, Pfizer, AbbVie, Chugai, Mitsubishi Tanabe.