medwireNews: People with late-onset rheumatoid arthritis (RA) have a similar likelihood of achieving remission as those with earlier-onset disease, indicating that treatment goals should be the same in both populations, researchers report.
For the study, Claire Bombardier (University of Toronto, Ontario, Canada) and team evaluated data from 354 patients diagnosed with RA at the age of 60 years or older and 518 patients with earlier-onset RA who were included in an Ontario registry in 2008–2020. The average age was 69.8 years in the late-onset group and 47.2 years in the earlier-onset group.
As reported in Arthritis Research & Therapy, the time from diagnosis to remission was comparable in the late- and earlier-onset RA groups after adjustment for demographic, disease, and treatment factors, at a median of 13.2 months and 11.9 months, respectively.
On the other hand, Bombardier and colleagues say that people with late-onset disease were significantly less likely to be taking biologics or Janus kinase (JAK) inhibitors (3 vs 8%) or nonsteroidal anti-inflammatory drugs (32 vs 42%) at baseline than those with earlier-onset RA. The proportion of patients taking conventional DMARD monotherapy in the two groups was 51% and 42%, respectively, while a corresponding 40% and 43% were taking combination DMARDs.
Therefore, “[w]hen deciding on the initial treatment regimen for [late-onset] RA, it is likely not necessary to start combination DMARDs or a biologic/JAK inhibitor,” as many of these patients were able to reach remission on conventional DMARDs, write Bombardier et al.
“This validates the current practice pattern where [late-onset] RA patients are typically not treated with combination DMARD or a biologic,” they add.
However, the researchers recommend that if people with late-onset RA do not achieve remission, then “treatment should be escalated in the same aggressive manner as [earlier-onset] RA patients,” and healthcare providers “should not hesitate to escalate and add a biologic or JAK inhibitor” for those who have not achieved remission on conventional DMARDs.
The study authors also found that a significantly higher proportion of patients with late-onset versus earlier-onset RA were on glucocorticoids at the time of remission (27 vs 13%).
Given the potential adverse effects of prolonged glucocorticoid therapy, these findings suggest that when late-onset RA patients achieve remission, “the rheumatologist should re-evaluate the treatment regimen and readjust the regimen if necessary to make it safer in the long term,” they write.
Bombardier et al conclude: “Future studies should evaluate if a standardized treatment protocol tailored to [late-onset] RA patients improves the safety of RA treatment and remission rate.”
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