Rheumatology, Vol 38, 228-234, Copyright © 1999 by British Society for Rheumatology
CT Pease, BB Bhakta, J Devlin and P Emery
OBJECTIVE: To identify factors affecting prognosis in patients with
late-onset rheumatoid arthritis (RA). METHODS: A total of 400 patients with
RA fulfilling the American College of Rheumatology criteria for diagnosis
were prospectively recruited from two hospital rheumatology centres. Of
these patients, 214 had disease onset above age 65 yr (LORA) and 186 below
age 65 yr (YORA). Follow-up clinical, functional, laboratory and
radiological assessments were compared. The Ritchie articular index (RAI)
and joint erosions were used as markers of disease activity and damage,
respectively. Disability was assessed using the Stanford Health Assessment
Questionnaire (HAQ). RESULTS: At median follow-up of 3.6 yr, the frequency
of joint erosions was similar (YORA, 51.6%; LORA, 54.2%). The remission
rate was greater in the LORA group (YORA, 20.4%; LORA, 45.8%, P < 0.01).
Factors associated with the development of erosions were: IgM rheumatoid
factor (RF) seropositivity [odds ratio (OR) = 4.24, 95% confidence interval
(CI) 2.56, 6.94], HLA DR4 (OR = 2.07, 95% CI 1.28, 3.35) and elevated
inflammatory markers (OR = 1.81, 95% CI 1.04, 3.14). Continuous steroid use
>3 months for the LORA group was associated with increased erosions (OR
= 4.09, 95% CI 1.81, 9.27). LORA patients (OR = 2.99, 95% CI 1.77, 5.02)
were more likely to go into remission and IgM RF-seropositive patients less
likely to go into clinical remission (OR = 0.47, 95% CI 0.28, 0.77). Female
patients with a high HAQ score at presentation experienced a poor
functional outcome (female OR = 3.01, 95% CI 1.59, 5.68; high HAQ OR =
3.02, 95% CI 1.98, 4.62). CONCLUSION: LORA can be as damaging as classical
RA and joint erosions are often observed at presentation. Being RF
seropositive, DR4 positive, and having elevated inflammatory markers at
onset, were associated with poor radiological outcome irrespective of age
of onset. Being female and having marked disability at presentation were
associated with poor functional outcome in both groups. These findings
suggest that treatment approaches used in classical YORA should be
instituted with equal vigour in patients with LORA.
ORIGINAL PAPERS
Does the age of onset of rheumatoid arthritis influence phenotype?: a prospective study of outcome and prognostic factors
Rheumatology and Rehabilitation Research Unit, University of Leeds, UK.
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