Late-onset, seropositive, erosive rheumatoid arthritis

This report describes the natural history, clinical features, and therapeutic requirements of late-onset seropositive and/or erosive rheumatoid arthritis (LORA). One hundred twenty-nine patients with mean disease duration of 6 years and mean age of disease onset of 66 years were studied. All patients met American Rheumatism Association criteria for rheumatoid arthritis (RA). Ninety-one percent were seropositive for rheumatoid factor, 83% had erosive disease, and 58% had significant medical problems. Therapeutically, most patients required sequential use of multiple second-line agents. Functional classification did not change significantly despite treatment, and complete remissions were unusual even with remittive therapy. It is concluded that a subset of LORA patients have seropositive aggressive, destructive disease.