Rexhepi Sylejman, Rexhepi Mjellma, Sahatçiu-Meka Vjollca, Rexhepi Blerta, Bahtiri Elton, Mahmutaj Vigan
Reumatizam. 2016;63(1):1-5.
Rheumatoid arthritis (RA) may have an onset at older age. The onset of the disease at the age of 60 and over is called late-onset rheumatoid arthritis (LORA). The aim of this study was to analyze the clinical, laboratory, radiological, and treatment characteristics of patients with LORA compared to those with early-onset RA (EaORA), provided that all the patients had an approximately equal duration of the disease. This is an observational single-center study, which involved 120 patients with an established diagnosis of RA, of which 60 patients had LORA, and 60 patients EaORA. The disease activity, measured by the Disease Activity Score 28 (DAS28-ESR), was significantly higher in the LORA group compared to the EaORA group (p<0.05). Significantly more patients with LORA had involvement of the shoulders (LORA vs. EaORA, 30% vs. 15%; p <0.05) and knees (LORA vs. EaORA, 46.7% vs. 16.7%; p <0.05). Radiological erosive changes were significantly more frequent in the LORA group in comparison with EaORA (p <0.05). There was no difference between the groups regarding rheumatoid factor (RF) positivity (p>0.05), while the number of patients positive for anti-citrullinated protein antibody (ACPA) was signifi cantly greater in the EaORA group (p<0.05). The values of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were significantly higher in the LORA than in the EaORA group. Hemoglobin levels were lower in the LORA group (11.96±1.64 g/dL) than in the EaORA group (12.18±1.56 g/dL). The most used disease-modifying antirheumatic drugs (DMARDs) were methotrexate and sulfasalazine, while biological drugs were not used. In conclusion, based on the results of our study, LORA has some features that distinguish it from EaORA, such as higher disease activity, more frequent involvement of large joints, and more pronounced structural damage. This should be taken in account in clinical practice, especially regarding treatment choices.
类风湿关节炎（RA）可能在老年发病。60岁及以上发病的该疾病被称为晚发型类风湿关节炎（LORA）。本研究的目的是分析LORA患者与早发型类风湿关节炎（EaORA）患者在临床、实验室、放射学及治疗方面的特征，前提是所有患者的病程大致相等。这是一项单中心观察性研究，纳入了120例确诊为RA的患者，其中60例为LORA患者，60例为EaORA患者。通过疾病活动评分28（DAS28-ESR）测量的疾病活动度，LORA组显著高于EaORA组（p<0.05）。LORA患者中肩部受累（LORA组 vs. EaORA组，30% vs. 15%；p<0.05）和膝部受累（LORA组 vs. EaORA组，46.7% vs. 16.7%；p<0.05）的患者明显更多。与EaORA相比，LORA组的放射学侵蚀性改变明显更常见（p<0.05）。两组在类风湿因子（RF）阳性方面无差异（p>0.05），而抗瓜氨酸化蛋白抗体（ACPA）阳性患者的数量在EaORA组显著更多（p<0.05）。LORA组的C反应蛋白（CRP）和红细胞沉降率（ESR）值显著高于EaORA组。LORA组的血红蛋白水平（11.96±1.64 g/dL）低于EaORA组（12.18±1.56 g/dL）。最常用的改善病情抗风湿药物（DMARDs）是甲氨蝶呤和柳氮磺胺吡啶，未使用生物药物。总之，基于我们的研究结果，LORA具有一些与EaORA不同的特征，如更高的疾病活动度、大关节更频繁受累以及更明显的结构损伤。在临床实践中应考虑到这一点，尤其是在治疗选择方面。
