Sugitani Naohiro, Tanaka Eiichi, Inoue Eisuke, Abe Mai, Sugano Eri, Saka Kumiko, Ochiai Moeko, Yamaguchi Rei, Ikari Katsunori, Yamanaka Hisashi, Harigai Masayoshi
Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Japan.
Showa University Research Administration Center, Showa University, Shinagawa-ku, Japan.
Rheumatology (Oxford). 2025 May 1;64(5):2541-2549. doi: 10.1093/rheumatology/keae673.
To compare treatment outcomes in patients with late-onset RA (LORA) and younger-onset RA (YORA).
We analyzed patients diagnosed with early RA (disease duration < 2 years) between 2000 and 2016 in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort. Patients were categorized into LORA (onset at ≥65 years) and YORA (onset at <65 years). The primary outcomes were changes in Clinical Disease Activity Index (CDAI) and Japanese version of the Health Assessment Questionnaire (J-HAQ) at Year 5. The secondary outcomes included the incidence of prespecified adverse events.
Methotrexate, biological disease-modifying anti-rheumatic drugs, and glucocorticoids were used in 70.6, 8.4 and 38.0% of the LORA group (n = 813, median age: 71 years), and 81.6, 19.4 and 32.0% of the YORA group (n = 2457, median age: 51 years). Both groups exhibited significant initial improvements in CDAI and J-HAQ scores. At Year 5, mean CDAI scores were 4.39 and 4.03 for the LORA and YORA groups, respectively. J-HAQ score for YORA remained stable below 0.5 after Year 2, whereas that for LORA worsened progressively. At Year 5, mean J-HAQ scores were 0.56 for LORA and 0.33 for YORA. Patients with LORA had a higher incidence of adverse events, with adjusted hazard ratios of 4.70 for death and 2.58 for malignancy.
Patients with LORA and YORA exhibited similar improvements in disease activity over 5 years; however, those with LORA demonstrated a more pronounced decline in physical function.
比较晚发型类风湿关节炎（LORA）患者和早发型类风湿关节炎（YORA）患者的治疗结局。
我们分析了2000年至2016年在风湿病研究所类风湿关节炎（IORRA）队列中被诊断为早期类风湿关节炎（病程<2年）的患者。患者被分为LORA组（发病年龄≥65岁）和YORA组（发病年龄<65岁）。主要结局是第5年时临床疾病活动指数（CDAI）和日本版健康评估问卷（J-HAQ）的变化。次要结局包括预设不良事件的发生率。
LORA组（n = 813，中位年龄：71岁）中70.6%、8.4%和38.0%的患者使用了甲氨蝶呤、生物改善病情抗风湿药和糖皮质激素，YORA组（n = 2457，中位年龄：51岁）中这一比例分别为81.6%、19.4%和32.0%。两组患者的CDAI和J-HAQ评分在初始时均有显著改善。在第5年时，LORA组和YORA组的平均CDAI评分分别为4.39和4.03。YORA组的J-HAQ评分在第2年后一直稳定在0.5以下，而LORA组的评分则逐渐恶化。在第5年时，LORA组的平均J-HAQ评分为0.56，YORA组为0.33。LORA组患者的不良事件发生率更高，死亡的调整风险比为4.70，恶性肿瘤的调整风险比为2.58。
LORA患者和YORA患者在5年的疾病活动改善方面表现相似；然而，LORA患者的身体功能下降更为明显。
