Thoughts and considerations on Elderly onset Rheumatoid Arthritis: A case-control study of a North African population

Rheumatoid arthritis (RA) is the most common chronic inflammatory joint disease, and elderly onset RA starting after age 65 (EORA) is on the rise constituting approximately one-third of RA cases.

To identify the clinical and therapeutic specificities of EORA.

This was a cross-sectional case-control study of 224 RA patients (recruitment was done over a 30-month period between 2018 and 2021). Two groups were evaluated: Elderly onset rheumatoid arthritis (EORA): patients in whom the disease started after the age of 65 and the young-onset rheumatoid arthritis (YORA) control group: patients with disease onset before the age of 65. We collected the clinical characteristics and we compared the therapeutic modalities between both groups: Results: Our study included 59 patients in the EORA group and 165 patients in the YORA group. The onset of RA in both groups was predominantly progressive and polyarticular. However, in the EORA group, rhizomelic involvement and abrupt onset were significantly more frequent than in the YORA group, with respectively (ORa=4.8 CI=1.5-15.6; p-0.01) and (ORa=5.1 CI=1.8-14; p-0.01). Methotrexate (MTX) was the most frequently used background treatment in both groups. There was no significant difference between the two groups in the prescription of the other conventional DMARDs. Adverse events were more frequently found in the EORA group (ORa=4.7 CI=1.3-16.4, p-0.05) and consisted mainly of gastrointestinal intolerance. Rehabilitation was advocated in 6.7% of the EORA group versus 16.9% of the YORA group, with a significant difference (ORa=4.73 [1.36-16.47), p=0.02).

In EORA patients, therapeutic modalities overlapped with those for young-onset RA. Therapeutic decisions should be carried out without depriving EORA patients with good biological age from advanced and auspicious treatment.