Clinical Characteristics of Young-Onset Versus Elderly-Onset Rheumatoid Arthritis: A Systematic Review and...

Area of Science:

• Rheumatology
• Immunology
• Geriatrics

Background:

• Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting 1% of the population, primarily women.
• RA onset is classified as young-onset (YORA, 16-65 years) or elderly-onset (EORA, >65 years).
• EORA may present acutely with systemic symptoms and large joint involvement due to age-related immune changes.

Purpose of the Study:

• To compare the clinical and epidemiological characteristics of EORA and YORA.
• To analyze differences in disease activity, joint involvement, and extra-articular manifestations between EORA and YORA.

Main Methods:

• Systematic review and meta-analysis of observational studies from major databases up to November 2023.
• Comparative analysis of EORA and YORA with a one-month clinical progression and treatment duration limit.
• Statistical analysis using a random effects model in RStudio with the 'meta' package.

Main Results:

• EORA patients trended towards higher disease activity at diagnosis (DAS28, SDAI) and greater disability (HAQ scores).
• A higher number of painful and swollen joints were observed in the EORA group.
• Extra-articular manifestations, including rheumatoid nodules and lung involvement, were significantly more common in EORA (p < 0.004).

Conclusions:

• EORA patients exhibit more severe onset disease, increased disability, and higher rates of extra-articular manifestations compared to YORA patients.
• Despite initial differences, long-term remission rates are comparable between EORA and YORA.
• Age is a significant factor influencing RA presentation and initial disease severity.