Yang Min, Liang Yan, Cen Xiao-min, Xie Qi-bing, Yin Geng
Sichuan Da Xue Xue Bao Yi Xue Ban. 2015 Mar;46(2):289-92.
To compare the disease activity and therapeutic strategy of late-onset rheumatoid arthritis (LORA) with young-onset rheumatoid arthritis (YORA).
Medical records of 259 patients with rheumatoid arthritis (RA) were reviewed retrospectively. The cut-off between LORA and YORA was operationally set at 60 years of age at disease onset. Gender ratio, disease duration, feature of involved joint, extra-articular features, laboratory features, disease activity score and treatment strategy were compared between LORA and YORA.
The LORA patients had a gender ratio (male/female) of 1/1.88, which was approaching 1/1 in the older age group. It took longer for LORA to be diagnosed than YORA (P<0.001). LORA had more frequent involvement of shoulders (P < 0.001), while elbow, wrist, metacarpophalangeal joint ( MCP), proximal interphalangeal joint (PIP) and ankle joints were more common in YORA (P<0.001). LORA patients were more likely to have anemia than YORA patients (P<0.05). No significant differences were found between LORA and YORA in specific serologic index, including rheumatoid factor and anticyclic citrullinated peptide antibody, and disease activity score 28-C-reactive protein (DAS28-CRP) and clinical disease activity index (CDAI). But LORA had a higher simplified disease activity index (SDAI) (P=0.002). Glucorcoticoid was used in 67.4% LORA patients, compared with 29.3% in YORA patients (P<0.001). In contrast, disease-modifying anti-rheumatic drugs (DMARDs) were used in 73.7% LORA patients, compared with 97.6% in YORA patients (P<0.001).
Delayed diagnose of LORA is common due to atypical presentation at disease onset. RA should be considered in elderly patients with large joints for differential diagnosis. LORA is more likely to have anemia than YORA, albeit no significant differences in serological index and extraarticular presentations. LORA patients should be treated with DMARDs as aggressively as YORA patients, if their comorbidities allow to do so.
比较晚发型类风湿关节炎（LORA）与早发型类风湿关节炎（YORA）的疾病活动度及治疗策略。
回顾性分析259例类风湿关节炎（RA）患者的病历。LORA与YORA的分界点在疾病发作时按实际操作设定为60岁。比较LORA和YORA之间的性别比例、病程、受累关节特征、关节外特征、实验室特征、疾病活动评分及治疗策略。
LORA患者的性别比例（男/女）为1/1.88，在老年组接近1/1。LORA的诊断时间比YORA长（P<0.001）。LORA中肩部受累更频繁（P<0.001），而肘部、腕部、掌指关节（MCP）、近端指间关节（PIP）和踝关节在YORA中更常见（P<0.001）。LORA患者比YORA患者更易出现贫血（P<0.05）。在类风湿因子、抗环瓜氨酸肽抗体等特异性血清学指标，以及疾病活动评分28- C反应蛋白（DAS28-CRP）和临床疾病活动指数（CDAI）方面，LORA与YORA之间未发现显著差异。但LORA的简化疾病活动指数（SDAI）较高（P=0.002）。67.4%的LORA患者使用了糖皮质激素，而YORA患者中这一比例为29.3%（P<0.001）。相比之下，73.7%的LORA患者使用了改善病情抗风湿药物（DMARDs），而YORA患者中这一比例为97.6%（P<0.001）。
由于疾病发作时的非典型表现，LORA延迟诊断很常见。老年大关节受累患者应考虑类风湿关节炎进行鉴别诊断。尽管血清学指标和关节外表现无显著差异，但LORA比YORA更易出现贫血。如果合并症允许，LORA患者应与YORA患者一样积极接受DMARDs治疗。
