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Nooh N, Lwin MN, Edwards C. Considerations for the use of biological therapies in elderly patients with rheumatoid arthritis. Expert Opin Biol Ther 2024:1-9. [PMID: 39267488 DOI: 10.1080/14712598.2024.2404521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 09/10/2024] [Accepted: 09/11/2024] [Indexed: 09/17/2024]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that primarily affects middle-aged individuals but is increasingly prevalent among the elderly due to longer life expectancies. Treating elderly onset RA (EORA) is challenging for clinicians because of unique disease characteristics, comorbidities, polypharmacy, age-related physiological changes, and limited studies on the safety and efficacy of biological therapies in this population. This review aims to evaluate the use of various biological therapies in elderly RA patients. AREAS COVERED This narrative review examines various aspects of RA in the elderly using published literature, randomized control trials, meta-analyses, and recommendations from the National Institute for Health and Care Excellence (NICE) and The European Alliance of Associations for Rheumatology (EULAR). EXPERT OPINION In EORA patients, the initiation of biological therapy is often delayed. Methotrexate remains the first-line treatment for both EORA and young onset RA (YORA). The combination of methotrexate and biological treatment shows comparable safety and efficacy in both EORA and YORA, except for rituximab, which is less effective in patients over 75. For elderly RA patients, biological (b-) disease-modifying antirheumatic drugs (DMARDs) are preferred as the first advanced therapy over targeted synthetic (ts-) DMARDs due to their superior safety profile.
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Affiliation(s)
- Noor Nooh
- NIHR clinical research facility, Southampton General Hospital, Southampton University Hospitals NHS Trust, Southampton, UK
| | - May N Lwin
- NIHR clinical research facility, Southampton General Hospital, Southampton University Hospitals NHS Trust, Southampton, UK
| | - Christopher Edwards
- NIHR clinical research facility, Southampton General Hospital, Southampton University Hospitals NHS Trust, Southampton, UK
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Asai S, Suzuki M, Hara R, Hirano Y, Nagamine S, Kaneko T, Suto T, Okano T, Yoshioka Y, Hirao M, Wakabayashi H, Fujibayashi T, Watanabe T, Takakubo Y, Ishikawa H, Nasu Y, Takemoto T, Kato T, Torikai E, Koyama K, Takagi H, Fujiwara T, Sobue Y, Ohashi Y, Nishiume T, Terabe K, Kojima M, Kojima T, Imagama S. Comparison of effectiveness of methotrexate in patients with late-onset versus younger-onset rheumatoid arthritis: Real-world data from an inception cohort in Japan (NICER-J). Mod Rheumatol 2024; 34:892-899. [PMID: 38491996 DOI: 10.1093/mr/roae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/17/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To compare the effectiveness of methotrexate (MTX) as initial therapy in patients with late-onset and younger-onset rheumatoid arthritis (LORA and YORA). METHODS Of 114 patients with YORA and 96 patients with LORA, defined as RA occurring at ≥65 years of age, enrolled in a multicentre RA inception cohort study, 71 and 66 patients who had been followed up to 6 months after starting MTX treatment were included in this study. RESULTS Proportions of patients on MTX treatment at 6 months were 96% and 92% in the YORA and LORA groups, respectively. Despite lower doses of MTX in the LORA group compared with the YORA group, no significant difference was observed in clinical disease activity index scores between the two groups throughout the follow-up period. The proportion of patients in clinical disease activity index remission at 6 months was 35% in both groups. Logistic regression analysis revealed that knee joint involvement and high Health Assessment Questionnaire-Disability Index were significant negative predictors of achieving clinical disease activity index remission at 6 months in the LORA group. CONCLUSION Observations up to 6 months revealed that the effectiveness of MTX administered based on rheumatologist discretion in patients with LORA is comparable to that in patients with YORA in clinical settings.
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Affiliation(s)
- Shuji Asai
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Mochihito Suzuki
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ryota Hara
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yuji Hirano
- Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan
| | - Satomi Nagamine
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Tetsuya Kaneko
- Department of Orthopedic Surgery, Japan Red Cross Society Fukaya Red Cross Hospital, Fukaya, Saitama, Japan
| | - Takahito Suto
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tadashi Okano
- Center for Senile Degenerative Disorders, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yutaka Yoshioka
- Department of Rheumatology, Handa City Hospital, Handa, Aichi, Japan
| | - Makoto Hirao
- Department of Orthopedic Surgery, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano, Osaka, Japan
| | - Hiroki Wakabayashi
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | | | - Tatsuo Watanabe
- Department of Orthopedic Surgery, Daido Hospital, Nagoya, Aichi, Japan
| | - Yuya Takakubo
- Department of Rehabilitation, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hajime Ishikawa
- Department of Rheumatology, Niigata Rheumatic Center, Shibata, Niigata, Japan
| | - Yoshihisa Nasu
- Department of Orthopedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Toki Takemoto
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | | | - Eiji Torikai
- Department of Rheumatology, Iwata City Hospital, Iwata, Shizuoka, Japan
| | - Kensuke Koyama
- Department of Orthopedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hideki Takagi
- Department of Orthopedic Surgery, Nagoya Central Hospital, Nagoya, Aichi, Japan
| | - Toshifumi Fujiwara
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasumori Sobue
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshifumi Ohashi
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tsuyoshi Nishiume
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenya Terabe
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | - Toshihisa Kojima
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Department of Orthopedic Surgery and Rheumatology, National Hospital Organization, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Sugihara T, Kawahito Y, Kaneko Y, Tanaka E, Yanai R, Yajima N, Kojima M, Harigai M. Systematic review for the treatment of older rheumatoid arthritis patients informing the 2024 update of the Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis. Mod Rheumatol 2024; 34:867-880. [PMID: 38445746 DOI: 10.1093/mr/roae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/09/2024] [Accepted: 02/17/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVES To update an evidence base informing the 2024 Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis (RA) in older adults. METHODS Four clinical questions (CQs) regarding efficacy and safety of drug treatment were evaluated, with CQ1 addressing methotrexate (MTX), CQ2 biological disease-modifying antirheumatic drugs, CQ3 Janus kinase (JAK) inhibitors, and CQ4 glucocorticoids (GCs). Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS Observational studies confirmed a pivotal role of methotrexate in the treatment of older RA patients. The meta-analysis showed that tumour necrosis factor inhibitors and JAK inhibitors were unequivocally effective in older RA patients. No data indicated that biological disease-modifying antirheumatic drugs were unsafe for older patients. No safety data for JAK inhibitor use in older patients were available. One randomized controlled trial demonstrated that long-term treatment with low-dose GCs increased risks of GC-associated adverse events. The certainty of overall evidence was very low for all CQs. CONCLUSIONS This systematic review provides the necessary evidence for developing 2024 Japan College of Rheumatology clinical practice guidelines for managing older patients with RA. Continued updates on the evidence of JAK inhibitors and GC are desired.
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Affiliation(s)
- Takahiko Sugihara
- Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Yutaka Kawahito
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Eiichi Tanaka
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Ryo Yanai
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Nobuyuki Yajima
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Masayo Kojima
- Nagoya City University, Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Hao Y, Oon S, Nikpour M. Efficacy and safety of treat-to-target strategy studies in rheumatic diseases: A systematic review and meta-analysis. Semin Arthritis Rheum 2024; 67:152465. [PMID: 38796922 DOI: 10.1016/j.semarthrit.2024.152465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND The concept of treat-to-target (T2T), a treatment strategy in which treatment is directed to reach and maintain a defined goal such as remission or low disease activity (LDA), has been explored for several diseases including rheumatic diseases such as rheumatoid arthritis (RA). However, a comprehensive review of T2T in all rheumatic diseases has not recently been undertaken. OBJECTIVE To perform a systematic review and meta-analysis of the efficacy and safety of a T2T strategy in the management of adult patients with inflammatory rheumatic diseases. METHODS PUBMED, EMBASE and CINAHL were searched from January 1990 to December 2023 using key words related to a T2T strategy and rheumatic diseases; T2T strategy clinical trials or observational studies were included. Clinical, physical function and radiologic outcomes, cost-effectiveness, and adverse events (AEs) of the T2T strategies were investigated and a random-effect meta-analysis was conducted for the most commonly used outcomes in RA studies. RESULTS The search identified 7896 studies, of which 66 fit inclusion criteria, including 50 in RA, 3 in psoriatic arthritis (PsA), 1 in spondyloarthritis (SpA) and 12 in gout. For the studies comparing a T2T strategy with usual care (UC) in RA, 83.3% (20/24) showed a T2T strategy could achieve significantly better clinical outcomes, and the meta-analysis showed that patients treated with a T2T strategy were more likely to be in remission (pooled RR: 1.68 (1.47-1.92), p<0.001] and achieve DAS-28 response (pooled standardised mean difference (SMD): 0.47 (0.26-0.69), P<0.001] at 1 year than patients treated with UC. Sensitivity analyses showed that a T2T strategy with a predefined treatment protocol had better clinical efficacy than that without protocol. In terms of improving physical function and health-related quality of life (HRQoL), 11/19 (57.9%) studies found a T2T strategy was significantly more likely to achieve these than UC, with the meta-analysis for the mean change of HAQ score supporting this conclusion (pooled SMD: 1.48 (0.46-2.51), p=0.004). Five out of 9 studies (55.6%) demonstrated greater benefit regarding radiographic progression from a T2T strategy. In terms of cost-effectiveness and AEs, 2/2 studies found a T2T strategy was more cost-effective than UC and 8/8 studies showed no tendency for AEs to occur more often with a T2T strategy. For the studies in PsA and SpA, a T2T strategy was also demonstrated to be more effective than UC in clinical and functional benefits, but not in radiologic outcomes. All gout studies showed that sUA level could be controlled more effectively with a T2T strategy, and 2 studies revealed that the T2T strategy could inhibit erosion development or crystal deposition. CONCLUSIONS For patients with active RA, a T2T strategy has been shown in mulitple studies to increase the likelihood of achieving clinical response and improving HRQoL without increasing economic costs and AEs. Limited studies have shown clinical and functional benefits from T2T strategies in active PsA and SpA. A T2T strategy has also been found to improve clinical and radiologic outcomes in gout. T2T trials in other rheumatic diseases are lacking.
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Affiliation(s)
- Yanjie Hao
- The University of Melbourne at St Vincent's Hospital, 29 Regent Street, Fitzroy, VIC 3065, Australia
| | - Shereen Oon
- The University of Melbourne at St Vincent's Hospital, 29 Regent Street, Fitzroy, VIC 3065, Australia; Department of Rheumatology, St. Vincent's Hospital Melbourne, 35 Victoria Parade, Fitzroy, VIC 3065, Australia.
| | - Mandana Nikpour
- The University of Melbourne at St Vincent's Hospital, 29 Regent Street, Fitzroy, VIC 3065, Australia; Department of Rheumatology, St. Vincent's Hospital Melbourne, 35 Victoria Parade, Fitzroy, VIC 3065, Australia; Sydney MSK Research Flagship Centre, The University of Sydney School of Public Health, Room 132, Edward Ford Building, Fisher Road, University of Sydney, NSW 2006, Australia; Royal Prince Alfred Hospital Institute of Rheumatology and Orthopedics, 59 Missenden Rd, Camperdown NSW 2050, Australia.
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Sugihara T, Tanaka E, Matsui T. Low-Dose Glucocorticoids in Older Patients with Rheumatoid Arthritis: What Does the Evidence Say? Drugs Aging 2024:10.1007/s40266-024-01133-w. [PMID: 39066877 DOI: 10.1007/s40266-024-01133-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 07/30/2024]
Abstract
The short-term use of glucocorticoids (GCs) in combination with methotrexate was recommended for the initial treatment of rheumatoid arthritis by the European League Against Rheumatism. A randomized controlled trial (GLORIA) showed that treatment of older patients with low-dose GCs in combination with disease-modifying anti-rheumatic drugs was more efficacious than disease-modifying anti-rheumatic drugs plus placebo in terms of disease activity control and prevention of joint destruction. Glucocorticoid-related adverse events were likely to increase relative to placebo, with no increase in serious adverse events and fractures over 2 years. Observational studies showed an increased risk of serious infections, cardiovascular events, and fractures associated with long-term continuation of GCs in older patients, but the adverse events may be associated not only with GC toxicity but also with poor disease control of rheumatoid arthritis. In the GLORIA study, low-dose GCs during 2 years could be tapered off safely, but many patients had a flare of disease activity after discontinuation of GCs. In the two representative large Japanese registries (IORRA and NinJa), the proportion of patients using GCs and non-tumor necrosis factor inhibitors increased with increasing age at disease onset, with a decreasing trend in methotrexate use. The proportion of patients in remission with GC treatment also increased with increasing age at onset. These suggested that it is not easy to discontinue GCs in older patients. If GCs cannot be terminated in the short term, it may be acceptable to use GCs to control disease activity for up to 2 years.
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Affiliation(s)
- Takahiko Sugihara
- Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Eiichi Tanaka
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Toshihiro Matsui
- Department of Rheumatology Research, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
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Miyashiro M, Asano T, Ishii Y, Miyazaki C, Shimizu H, Masuda J. Treatment Patterns of Biologic Disease-Modifying Antirheumatic Drugs and Janus Kinase Inhibitors in Patients with Rheumatoid Arthritis in Japan: A Claims-Based Cohort Study. Drugs Real World Outcomes 2024; 11:285-297. [PMID: 38598110 PMCID: PMC11176134 DOI: 10.1007/s40801-024-00423-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Reports on treatment patterns of biologic disease-modifying antirheumatic drugs (bDMARDs)/Janus kinase inhibitors (JAKi) for rheumatoid arthritis (RA) in clinical practice are still sparse in Japan, especially in combination with conventional synthetic DMARDs (csDMARDs). OBJECTIVES The aim of this study was to investigate treatment patterns of bDMARD/JAKi in the treatment of RA in real-world clinical practice in Japan. METHOD A retrospective cohort study was conducted using the Japanese Medical Data Vision health claims database. The inclusion criteria required a recorded diagnosis of RA, defined by ICD-10 codes, in patients aged 18 years and older on the index date. We analyzed 39,903 RA patients treated with DMARDs from 2008 to 2020. RESULTS Among analyzed subjects, 10,196 patients (25.6%) were prescribed bDMARDs/JAKi in combination with csDMARDs, and 3067 patients (7.7%) were prescribed these drugs without csDMARDs. Among the bDMARDs/JAKi, tumor necrosis factor inhibitors (TNFi) were the most commonly prescribed DMARD overall, and also the most common first-line therapy, accounting for 60.0% or 45.5% of patients prescribed these drugs in combination with or without csDMARDs, respectively. Switching, temporary discontinuation (restarting with the same agents), and discontinuation of bDMARDs/JAKi were observed in 3150 (30.9%), 1379 (13.5%), and 2025 (19.9%) patients with csDMARDs, and in 849 (27.7%), 513 (16.7%), and 833 (27.2%) patients without csDMARDs, respectively. CONCLUSIONS Real-world treatment trajectories of bDMARDs/JAKi with and without csDMARDs was analyzed in RA patients in Japan between 2008 and 2020. TNFi were the predominant first-line therapy, and likely to be switched to different classes. Understanding the current treatment patterns, including discontinuation, is important to find an optimal treatment strategy for RA patients.
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Affiliation(s)
- Masahiko Miyashiro
- Immunology and Infectious Diseases Department, Medical Affairs Division, Janssen Pharmaceutical K.K., Nishi Kanda 3-5-2, Chiyoda-Ku, Tokyo, 101-0065, Japan
| | - Teita Asano
- Immunology and Infectious Diseases Department, Medical Affairs Division, Janssen Pharmaceutical K.K., Nishi Kanda 3-5-2, Chiyoda-Ku, Tokyo, 101-0065, Japan.
| | - Yutaka Ishii
- Immunology and Infectious Diseases Department, Medical Affairs Division, Janssen Pharmaceutical K.K., Nishi Kanda 3-5-2, Chiyoda-Ku, Tokyo, 101-0065, Japan
| | - Celine Miyazaki
- Value, Evidence and Access Department, Janssen Pharmaceutical K.K., Nishi Kanda 3-5-2, Chiyoda-Ku, Tokyo, 101-0065, Japan
| | - Hirohito Shimizu
- Medical Affairs Division, Medical Excellence Department, Janssen Pharmaceutical K.K., Nishi Kanda 3-5-2, Chiyoda-Ku, Tokyo, 101-0065, Japan
| | - Junya Masuda
- Immunology and Infectious Diseases Department, Medical Affairs Division, Janssen Pharmaceutical K.K., Nishi Kanda 3-5-2, Chiyoda-Ku, Tokyo, 101-0065, Japan
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Kojima M, Sugihara T, Kawahito Y, Kojima T, Kaneko Y, Ishikawa H, Abe A, Matsui K, Hirata S, Kishimoto M, Tanaka E, Morinobu A, Hashimoto M, Matsushita I, Hidaka T, Matsui T, Nishida K, Asai S, Ito H, Harada R, Harigai M. Consensus statement on the management of late-onset rheumatoid arthritis. Mod Rheumatol 2024:roae011. [PMID: 38511322 DOI: 10.1093/mr/roae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/08/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES Late-onset rheumatoid arthritis (LORA), which has been increasing in recent years, lacks evidence for initial treatment. Japanese rheumatology experts recognized this gap and addressed it by developing consensus statements on the first clinical application of LORA. METHODS These statements were created following an introductory discussion about treatment fundamentals, which included a review of existing literature and cohort data. The steering committee created a draft, which was refined using a modified Delphi method that involved panel members reaching a consensus. The panel made decisions based on input from geriatric experts, clinical epidemiologists, guideline developers, patient groups, and the LORA Research Subcommittee of the Japan College of Rheumatology. RESULTS The consensus identified four established facts, three basic approaches, and six expert opinions for managing LORA. Methotrexate was recommended as the primary treatment, with molecular-targeted agents being considered if treatment goals cannot be achieved. An emphasis was placed on assessing the lives of older patients due to challenges in risk management and methotrexate accessibility caused by comorbidities or cognitive decline. CONCLUSIONS The experts substantiated and refined 13 statements for the initial treatment of LORA. To validate these claims, the next is to conduct a registry study focusing on new LORA cases.
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Affiliation(s)
- Masayo Kojima
- Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
- Department of Frailty Research, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Takahiko Sugihara
- Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Yutaka Kawahito
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hajime Ishikawa
- Department of Rheumatology, Niigata Rheumatic Center, Shibata, Niigata, Japan
| | - Asami Abe
- Department of Rheumatology, Niigata Rheumatic Center, Shibata, Niigata, Japan
| | - Kazuo Matsui
- Department of Rheumatology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Eiichi Tanaka
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Motomu Hashimoto
- Department of Clinical Immunology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Isao Matsushita
- Department of Rehabilitation Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Toshihiko Hidaka
- Institute of Rheumatology, Miyazaki-Zenjinkai Hospital, Miyazaki, Japan
| | - Toshihiro Matsui
- Department of Rheumatology Research, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | | | - Shuji Asai
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiromu Ito
- Department of Orthopedic Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Ryozo Harada
- Department of Orthopaedic Surgery, Kurashiki Sweet Hospital, Kurashiki, Okayama, Japan
| | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Matsumoto T, Sugihara T, Hosoya T, Ishizaki T, Kubo K, Kamiya M, Baba H, Tsuchida M, Hirano F, Kojima M, Miyasaka N, Harigai M. Effectiveness and safety of treat-to-target strategy for methotrexate-naïve rheumatoid arthritis patients >75 years of age. Rheumatol Adv Pract 2024; 8:rkae019. [PMID: 38425693 PMCID: PMC10904149 DOI: 10.1093/rap/rkae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Objectives To identify differences in effectiveness and safety of a treat-to-target (T2T) strategy comparing late-onset MTX-naïve RA patients (LORA) ≥75 or <75 years of age. Methods Treatment was adjusted to target low disease activity with conventional synthetic DMARDs followed by biologic DMARDs (bDMARDs) in LORA ≥75 years (n = 98, mean age 80.0 years) and LORA <75 years (n = 99) with moderate-high disease activity. Achievement of Simplified Disease Activity Index (SDAI) remission at week 156 by non-responder imputation analysis was evaluated as a primary outcome. Results LORA ≥75 years had more comorbidities than LORA <75 years, but SDAI and ACPA positivity were similar at baseline. Of the LORA ≥75 years, 70.4% started MTX and 34.1% and 37.1% received a bDMARD at week 52 and 156, respectively (very similar to the LORA <75 years). Glucocorticoid use was more frequent in the LORA ≥75 years than in the LORA <75 years. Comorbidities/adverse events more frequently contributed to the reasons for non-adherence to T2T in the LORA ≥75 than in the LORA <75. At week 156, 32.7% of the LORA ≥75 and 66.7% of the LORA <75 achieved SDAI remission (P < 0.001). The cumulative incidence of serious adverse events (SAEs) over 156 weeks was 42.8% in the LORA ≥75 and 22.1% in the LORA <75. Multivariable analysis indicated an increased risk of SDAI non-remission at week 156 in the LORA ≥75 [odds ratio 2.82 (95% CI 1.29. 6.14)] after adjusting for comorbidities at baseline, non-adherence to T2T and SAEs. Conclusions It was more difficult to achieve remission in the LORA ≥75 patients than in the LORA <75 patients due to both poor treatment response and safety issues.
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Affiliation(s)
- Takumi Matsumoto
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiko Sugihara
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
- Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Tadashi Hosoya
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kanae Kubo
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Mari Kamiya
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Baba
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Marina Tsuchida
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Fumio Hirano
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masayo Kojima
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Nobuyuki Miyasaka
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
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9
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Komiya Y, Sugihara T, Hirano F, Matsumoto T, Kamiya M, Sasaki H, Hosoya T, Kimura N, Ishizaki T, Mori M, Tohma S, Yasuda S, Matsui T. Factors associated with impaired physical function in elderly rheumatoid arthritis patients who had achieved low disease activity. Mod Rheumatol 2023; 34:60-67. [PMID: 36484523 DOI: 10.1093/mr/roac151] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/15/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2023]
Abstract
OBJECTIVES We aimed to investigate factors associated with impaired physical function [defined as Health Assessment Questionnaire Disability Index (HAQ-DI) >0.5] of old-old (aged 75-84 years) patients with rheumatoid arthritis. METHODS Data from 15,185 rheumatoid arthritis patients in the National Database of Rheumatic Disease in Japan were extracted from 2017 to 2018. We enrolled 3708 patients aged 55-84 years in Simplified Disease Activity Index (SDAI) ≤11 and Steinbrocker Stage I/II. Factors associated with HAQ-DI >0.5 were analysed by multivariable logistic regression. RESULTS About half of the old-old patients received methotrexate, which was lower than middle-aged (55-64 years) and young-old patients (65-74 years). The proportion of glucocorticoids in the old-old patients was highest among the three groups, and biological disease-modifying antirheumatic drugs were similarly used. The prevalence of HAQ-DI >0.5 was significantly higher in old-old patients with low disease activity than in those with remission. The same was true in the middle-aged and young-old patients. Multivariable analysis showed age, higher SDAI, glucocorticoid use, and methotrexate nonuse were significantly associated with HAQ-DI >0.5 in the old-old patients. CONCLUSIONS Achieving SDAI remission was an ideal goal for old-old patients in terms of physical function. Glucocorticoids and a low proportion of methotrexate use may influence the physical function of old-old patients.
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Affiliation(s)
- Yoji Komiya
- Department of Rheumatology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takahiko Sugihara
- Department of Rheumatology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Division of Rheumatology and Allergy, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
- 2-16-1, Sugao, Miyamae-Ku, Kawasaki, 216-8511, Japan
| | - Fumio Hirano
- Department of Rheumatology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takumi Matsumoto
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Mari Kamiya
- Department of Rheumatology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hirokazu Sasaki
- Department of Rheumatology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tadashi Hosoya
- Department of Rheumatology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Naoki Kimura
- Department of Rheumatology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Masaaki Mori
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shigeto Tohma
- Department of Rheumatology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Shinsuke Yasuda
- Department of Rheumatology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Toshihiro Matsui
- Department of Rheumatology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Department of Rheumatology Research, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
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10
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Pavlov-Dolijanovic S, Bogojevic M, Nozica-Radulovic T, Radunovic G, Mujovic N. Elderly-Onset Rheumatoid Arthritis: Characteristics and Treatment Options. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1878. [PMID: 37893596 PMCID: PMC10608066 DOI: 10.3390/medicina59101878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/01/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
Elderly-onset rheumatoid arthritis (EORA) is a distinct clinical entity defined as the onset of rheumatoid arthritis (RA) in individuals aged over 60 years. EORA presents unique clinical features, including a more equitable distribution of sexes, a potential predilection for male involvement, a higher incidence of acute onset characterized by constitutional symptoms, a propensity for systemic manifestations, elevated sedimentation rates at disease onset, a reduced occurrence of rheumatoid factor positivity, increased titers of anti-citrullinated protein antibodies, a preference for involvement of large joints, elevated disease activity, the presence of bone erosions, and heightened patient disability. RA is recognized to consist of three partially overlapping subsets. One subset mirrors the classical RA clinical presentation, while the remaining subsets exhibit either a polymyalgia rheumatica-like phenotype or present with remitting seronegative symmetrical synovitis accompanied by pitting edema syndrome. In the initial stages of EORA management, non-steroidal anti-inflammatory drugs (NSAIDs) are not typically the first-line treatment choice, because seniors are much more prone to develop side effects due to NSAIDs, and the use of NSAIDs is in reality contraindicated to the majority of seniors due to comorbidities. Disease-modifying antirheumatic drugs (DMARDs), frequently methotrexate, are introduced immediately after the diagnosis is made. In cases where elderly patients demonstrate resistance to conventional DMARD therapy, the introduction of biological or targeted synthetic DMARDs becomes a viable treatment option. EORA presents a unique clinical profile, necessitating tailored treatment strategies. Our study emphasizes the challenges of NSAID use in seniors, highlighting the imperative shift toward DMARDs such as methotrexate. Future research should explore personalized DMARD approaches based on disease activity, comorbidities, and safety considerations, aiming to optimize treatment outcomes and minimize glucocorticoid reliance, thereby enhancing the quality of care for EORA patients.
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Affiliation(s)
| | - Milan Bogojevic
- Clinical Centre of Montenegro, Department of Rheumatology, 81000 Podgorica, Montenegro;
| | - Tatjana Nozica-Radulovic
- Faculty of Medicine, Institute for Physical Medicine and Rehabilitation and Orthopedic Surgery “Dr. Miroslav Zotovic”, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina;
| | - Goran Radunovic
- University of Belgrade, Faculty of Medicine, Institute of Rheumatology, 11000 Belgrade, Serbia;
| | - Natasa Mujovic
- University of Belgrade, Faculty of Medicine, Center for Physical Medicine and Rehabilitation, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
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11
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Messelink MA, den Broeder AA, Marinelli FE, Michgels E, Verschueren P, Aletaha D, Tekstra J, Welsing PMJ. What is the best target in a treat-to-target strategy in rheumatoid arthritis? Results from a systematic review and meta-regression analysis. RMD Open 2023; 9:e003196. [PMID: 37116986 PMCID: PMC10152050 DOI: 10.1136/rmdopen-2023-003196] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVES A treat-to-target (T2T) strategy has been shown to be superior to usual care in rheumatoid arthritis (RA), but the optimal target remains unknown. Targets are based on a disease activity measure (eg, Disease Activity Score-28 (DAS28), Simplified Disease Activity Indices/Clinical Disease Activity Indices (SDAI/CDAI), and a cut-off such as remission or low disease activity (LDA). Our aim was to compare the effect of different targets on clinical and radiographic outcomes. METHODS Cochrane, Embase and (pre)MEDLINE databases were searched (1 June 2022) for randomised controlled trials and cohort studies after 2003 that applied T2T in RA patients for ≥12 months. Data were extracted from individual T2T study arms; risk of bias was assessed with the Cochrane Collaboration tool. Using meta-regression, we evaluated the effect of the target used on clinical and radiographic outcomes, correcting for heterogeneity between and within studies. RESULTS 115 treatment arms were used in the meta-regression analyses. Aiming for SDAI/CDAI-LDA was statistically superior to targeting DAS-LDA regarding DAS-remission and SDAI/CDAI/Boolean-remission outcomes over 1-3 years. Aiming for SDAI/CDAI-LDA was also significantly superior to DAS-remission regarding both SDAI/CDAI/Boolean-remission (over 1-3 years) and mean SDAI/CDAI (over 1 year). Targeting DAS-remission rather than DAS-LDA only improved the percentage of patients in DAS-remission, and only statistically significantly after 2-3 years of T2T. No differences were observed in Health Assessment Questionnaire and radiographic progression. CONCLUSIONS Targeting SDAI/CDAI-LDA, and to a lesser extent DAS-remission, may be superior to targeting DAS-LDA regarding several clinical outcomes. However, due to the risk of residual confounding and the lack of data on (over)treatment and safety, future studies should aim to directly and comprehensively compare targets. PROSPERO REGISTRATION NUMBER CRD42021249015.
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Affiliation(s)
| | | | | | - Edwin Michgels
- Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - P Verschueren
- Rheumatology, KU Leuven University Hospitals, Leuven, Belgium
| | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Janneke Tekstra
- Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Paco M J Welsing
- Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
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12
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Kawahito Y, Morinobu A, Kaneko Y, Kohno M, Hirata S, Kishimoto M, Seto Y, Sugihara T, Tanaka E, Ito H, Kojima T, Matsushita I, Nishida K, Mori M, Murashima A, Yamanaka H, Nakayama T, Kojima M, Harigai M. Drug treatment algorithm and recommendations from the 2020 update of the Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis-secondary publication. Mod Rheumatol 2023; 33:21-35. [PMID: 35297492 DOI: 10.1093/mr/roac017] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/05/2022] [Accepted: 02/09/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study was to update the Japan College of Rheumatology (JCR) clinical practice guidelines (CPG) for the management of rheumatoid arthritis (RA; JCR CPG for RA) according to recent changes in the medical environment in Japan. This article is a digest version of the guidance. METHODS We used the Grading of Recommendations, Assessment, Development, and Evaluation method to update the 2014 JCR CPG for RA. A consensus was formed by CPG panel members. RESULTS We identified 36 important clinical questions regarding drug treatment and developed corresponding recommendations for RA. The recommendations included the following RA medications: non-steroidal anti-inflammatory drugs, corticosteroids, conventional synthetic disease-modifying antirheumatic drugs, biological disease-modifying antirheumatic drugs, anti-receptor activator for nuclear factor-κB ligand antibodies, and Janus kinase inhibitors, as well as the tapering and discontinuation of these medications. Recommendations regarding the efficacy and safety of treatments in the elderly and patients with comorbidities were also developed. Finally, we used these recommendations to create an original algorithm for drug treatment for RA based on the Treat-to-Target approach. CONCLUSION The 2020 JCR CPG for RA provides a useful tool for rheumatologists, health care professionals, and patients with RA, enabling shared decision-making in a variety of clinical situations.
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Affiliation(s)
- Yutaka Kawahito
- Inflammation and Immunology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuko Kaneko
- Department of Internal Medicine, Division of Rheumatology, Keio University School of Medicine, Tokyo, Japan
| | - Masataka Kohno
- Inflammation and Immunology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Yohei Seto
- Department of Rheumatology, Yachiyo Medical Center, Tokyo Women's Medical University, Yachiyo, Japan
| | - Takahiko Sugihara
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Eiichi Tanaka
- Department of Internal Medicine, Division of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Hiromu Ito
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Orthopaedic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Isao Matsushita
- Department of Rehabilitation Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Keiichiro Nishida
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan
| | - Masaaki Mori
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Atsuko Murashima
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine/Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan
| | | | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Masayo Kojima
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Masayoshi Harigai
- Department of Internal Medicine, Division of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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13
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Kojima M, Kawahito Y, Sugihara T, Kojima T, Harada R, Hirata S, Hashimoto M, Hidaka T, Ishikawa H, Ito H, Kishimoto M, Kaneko Y, Matsui K, Matsui T, Matsushita I, Morinobu A, Nishida K, Tanaka E, Abe A, Ishitoku M, Asai S, Kida T, Onishi A, Takanashi S, Harigai M. Late-onset rheumatoid arthritis registry study, LORIS study: study protocol and design. BMC Rheumatol 2022; 6:90. [PMID: 36567352 PMCID: PMC9791765 DOI: 10.1186/s41927-022-00322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/16/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Although drug treatment strategies for rheumatoid arthritis (RA) are relatively well established, there is a paucity of evidence on the treatment in older patients. The purpose of this study is to build a registry for late-onset RA (LORA), which is expected to increase rapidly worldwide. In addition, we aim to propose optimal treatment strategies according to the patient background including frailty, thereby contributing to improving the quality of treatment and daily living in patients with RA. METHODS/DESIGN The LORIS (Late-onset Rheumatoid Arthritis Registry) Study is a prospective nation-wide multicenter observational study of patients with LORA. The inclusion criteria were patients aged ≥ 65 years at onset, meeting 2010 ACR/EULAR classification criteria for RA, and starting either any disease-modifying antirheumatic drugs (DMARDs) in a DMARD-naïve patient or the first biologic/targeted synthetic DMARDs during the study period. Enrollment was started on 11 January, 2022 and will be closed on 31 December, 2023. Patients will undergo a comprehensive baseline assessment including clinical data, medication, cognitive and physical function, psychosocial factors, and frailty. Data will be collected at baseline, Month 3, 6, 12, 18, 24, 36, and summarized descriptively. The factors associated with adverse events and achieving remission will be determined. DISCUSSION A multi-disciplinary panel including patients, rheumatologists, and geriatric specialists will discuss the results and build a consensus regarding the treatment goals of LORA. We expect to provide a broad range of information for evidence-based shared decision making in the treatment of LORA. STUDY REGISTRATION Registered at the UMIN registry (UMIN000046086) on 1 January 2022.
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Affiliation(s)
- Masayo Kojima
- grid.260433.00000 0001 0728 1069Nagoya City University, Kawasumi1, Mizuho, Nagoya, Aichi 466-8601 Japan ,grid.419257.c0000 0004 1791 9005National Center for Geriatrics and Gerontology, 7-430, Morioka-Cho, Obu City, Aichi 474-8511 Japan
| | - Yutaka Kawahito
- grid.272458.e0000 0001 0667 4960Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kyoto Japan
| | - Takahiko Sugihara
- grid.412764.20000 0004 0372 3116Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Kanagawa Japan
| | - Toshihisa Kojima
- grid.410840.90000 0004 0378 7902Department of Orthopaedic Surgery, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi Japan
| | - Ryozo Harada
- Department of Orthopaedic Surgery, Kurashiki Sweet Hospital, Kurashiki, Okayama Japan
| | - Shintaro Hirata
- grid.470097.d0000 0004 0618 7953Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Hiroshima Japan
| | - Motomu Hashimoto
- grid.258799.80000 0004 0372 2033Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Osaka Japan
| | | | - Hajime Ishikawa
- Department of Rheumatology, Niigata Rheumatic Center, Shibata, Niigata Japan
| | - Hiromu Ito
- grid.415565.60000 0001 0688 6269Kurashiki Central Hospital, Kurashiki, Okayama Japan
| | - Mitsumasa Kishimoto
- grid.411205.30000 0000 9340 2869Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Mitaka, Tokyo Japan
| | - Yuko Kaneko
- grid.26091.3c0000 0004 1936 9959Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Matsui
- grid.416933.a0000 0004 0569 2202Department of Rheumatology, Teine Keijinkai Hospital, Sapporo, Hokkaido Japan
| | - Toshihiro Matsui
- grid.415689.70000 0004 0642 7451Department of Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa Japan
| | - Isao Matsushita
- grid.411998.c0000 0001 0265 5359Department of Rehabilitation Medicine, Kanazawa Medical University, Kanazawa, Ishikawa Japan
| | - Akio Morinobu
- grid.258799.80000 0004 0372 2033Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Keiichiro Nishida
- grid.261356.50000 0001 1302 4472Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Okayama Japan
| | - Eiichi Tanaka
- grid.410818.40000 0001 0720 6587Division of Rheumatology, Department of Internal Medicine, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
| | - Asami Abe
- Department of Rheumatology, Niigata Rheumatic Center, Shibata, Niigata Japan
| | - Michinori Ishitoku
- grid.27476.300000 0001 0943 978XDepartment of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi Japan
| | - Shuji Asai
- grid.470097.d0000 0004 0618 7953Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Hiroshima Japan
| | - Takashi Kida
- grid.272458.e0000 0001 0667 4960Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kyoto Japan
| | - Akira Onishi
- grid.258799.80000 0004 0372 2033Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Japan
| | - Satoshi Takanashi
- grid.26091.3c0000 0004 1936 9959Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masayoshi Harigai
- grid.410818.40000 0001 0720 6587Division of Rheumatology, Department of Internal Medicine, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
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14
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Novella-Navarro M, Balsa A. Difficult-to-Treat Rheumatoid Arthritis in Older Adults: Implications of Ageing for Managing Patients. Drugs Aging 2022; 39:841-849. [PMID: 36104655 PMCID: PMC9626415 DOI: 10.1007/s40266-022-00976-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
Difficult-to-treat rheumatoid arthritis is a heterogeneous term in which patients may present with difficulties in their management for different reasons. This can ultimately lead to patients being exposed to multiple treatments because of inefficacy (resulting from mechanisms intrinsic to rheumatoid arthritis or from non-inflammatory causes such as chronic pain syndrome or structural damage, among others), toxicity or adverse effects that may be linked to comorbidities. One particular group in which such characteristics may be more patent is older patients. Increasing life expectancy, an ageing population and the late onset of rheumatoid arthritis have led to an increased interest in the particularities of treating older patients. This may pose a challenge for physicians, as ageing has implications for optimal patient treatment owing to the potential presence of comorbidities, the risk of adverse events and perceptions of disease status by both physicians and patients. All of these factors may have implications for classifying and managing patients aged > 65 years as difficult-to-treat rheumatoid arthritis, as these patients could be misclassified. This can occur when a significant proportion may still exhibit signs of active disease but not necessarily be difficult to treat because the treatment criterion has not been fulfilled. Alternatively, patients may be exposed to multiple biologic/targeted disease-modifying antirheumatic drugs because of contraindications and/or comorbid conditions. Treatment-to-target strategies and an adequate assessment of inflammatory rheumatoid arthritis activity in older patients should be undertaken, taking special care with associated comorbidities, polypharmacy and risk profiles. Such an approach can help to ensure appropriate treatment for older adults and avoid the misclassification of difficult-to-treat patients.
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Affiliation(s)
| | - Alejandro Balsa
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
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15
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Sugihara T, Kawahito Y, Morinobu A, Kaneko Y, Seto Y, Kojima T, Ito H, Kohno M, Nakayama T, Sobue Y, Nishida K, Matsushita I, Murashima A, Mori M, Tanaka E, Hirata S, Kishimoto M, Yamanaka H, Kojima M, Harigai M. Systematic review for the treatment of older rheumatoid arthritis patients informing the 2020 update of the Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis. Mod Rheumatol 2022; 32:313-322. [PMID: 33853484 DOI: 10.1080/14397595.2021.1912922] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To provide an evidence base for clinical practice guidelines (CPG) for the management of rheumatoid arthritis (RA) in older adults. METHODS PubMed, Cochrane library, and Japan Centra Revuo Medicina databases were searched for articles published between 1990 and 2019. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system, with some modifications. RESULTS Among 702 identified articles, there were 5 post-hoc analyses of randomized controlled trials and 10 observational studies. Meta-analysis of the former yielded a mean difference of the van der Heijde-modified total Sharp score of -2.79 (95% confidence interval [CI] - 3.74 to -1.84) for treatment with tumor necrosis factor inhibitors. The risk ratio (RR) for the American College of Rheumatology 50% response rate, and for serious adverse events was 2.83 (95%CI 1.90-4.21) and 1.32 (95%CI 0.53-3.31), respectively, for Janus kinase inhibitors. Meta-analysis of the observational studies yielded an RR for disease activity score-28 remission and serious infections of 0.76 (95%CI 0.64-0.91) and 1.92 (95%CI 1.31-2.81) for older-versus-younger patients receiving biological disease-modifying antirheumatic drugs, respectively. CONCLUSION This systematic review provides the necessary evidence for developing CPG for the management of RA in older adults.
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Affiliation(s)
- Takahiko Sugihara
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yutaka Kawahito
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuko Kaneko
- Department of Internal Medicine, Division of Rheumatology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Seto
- Department of Rheumatology, Yachiyo Medical Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiromu Ito
- Department of Advanced Medicine for Rheumatic Diseases and Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masataka Kohno
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Yasumori Sobue
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Orthopedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Keiichiro Nishida
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan
| | - Isao Matsushita
- Department of Rehabilitation Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Atsuko Murashima
- Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine/Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan
| | - Masaaki Mori
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eiichi Tanaka
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | | | - Masayo Kojima
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu City, Japan
| | - Masayoshi Harigai
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Takahashi S, Kondo N, Kijima Y, Kakutani R, Ishikawa H, Kawashima H. Ankle arthrodesis using a retrograde intramedullary rod with fins for highly destructive joints in elderly patients with rheumatoid arthritis: A report of two cases. Clin Case Rep 2022; 10:e05348. [PMID: 35154716 PMCID: PMC8819640 DOI: 10.1002/ccr3.5348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/10/2022] Open
Abstract
Herein, we present two cases of older adult patients with highly destructive changes in ankle joints (Larsen grade IV) who underwent retrograde intramedullary ankle nail fixation with fins. In both patients, bony union was achieved, and full weight-bearing was attained at 3 months after surgery.
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Affiliation(s)
- Shun Takahashi
- Division of Orthopedic SurgeryDepartment of Regenerative and Transplant MedicineNiigata University Graduate School of Medical and Dental ScienceNiigataJapan
| | - Naoki Kondo
- Division of Orthopedic SurgeryDepartment of Regenerative and Transplant MedicineNiigata University Graduate School of Medical and Dental ScienceNiigataJapan
| | - Yasufumi Kijima
- Division of Orthopedic SurgeryDepartment of Regenerative and Transplant MedicineNiigata University Graduate School of Medical and Dental ScienceNiigataJapan
| | - Rika Kakutani
- Division of Orthopedic SurgeryDepartment of Regenerative and Transplant MedicineNiigata University Graduate School of Medical and Dental ScienceNiigataJapan
| | - Hajime Ishikawa
- Department of RheumatologyNiigata Rheumatic CenterShibataJapan
| | - Hiroyuki Kawashima
- Division of Orthopedic SurgeryDepartment of Regenerative and Transplant MedicineNiigata University Graduate School of Medical and Dental ScienceNiigataJapan
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17
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Sugihara T. Treatment strategies for elderly-onset rheumatoid arthritis in the new era. Mod Rheumatol 2021; 32:493-499. [PMID: 34791359 DOI: 10.1093/mr/roab087] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022]
Abstract
Elderly-onset rheumatoid arthritis (EORA) is characterized by acute onset and clinical features of high disease activity. Anti-cyclic citrullinated peptide antibody (ACPA) positivity or the presence of bone erosions predicts a radiological joint destruction of EORA, but ACPA-negative EORA with a polymyalgia rheumatica (PMR) phenotype may also present. Biological disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors were beneficial both in older and in younger patients in terms of risk-benefit balance. Implementation of a treat-to-target strategy could improve EORA outcomes, but older patients have more age-related comorbidities and interstitial lung disease than younger patients. Baseline comorbidities, more frequent methotrexate dose-dependent adverse events, serious infections, cardiovascular disease events, and malignancy all influence the choice of treatment and the treatment goals for older patients. Based on articles reviewed here, it is suggested that current treatment strategies for younger patients are also useful for ACPA-positive EORA and for ACPA-negative EORA with bone erosion. Differential diagnosis of ACPA-negative EORA without erosive arthritis and PMR with peripheral manifestations is challenging, and the treatment strategy of patients presenting with this overlap phenotype remained unclear. An appropriate treatment strategy for all patients with EORA still needs to be developed.
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Affiliation(s)
- Takahiko Sugihara
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Internal Medicine, Division of Rheumatology and Allergy, St. Marianna University School of Medicine, Kawasaki, Japan
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Abatacept is Efficacious in the Treatment of Older Patients with csDMARD-Refractory Rheumatoid Arthritis: A Prospective, Multicenter, Observational Study. Rheumatol Ther 2021; 8:1585-1601. [PMID: 34448173 PMCID: PMC8572263 DOI: 10.1007/s40744-021-00356-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/02/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Abatacept efficacy in older patients with rheumatoid arthritis (RA) has been primarily demonstrated via retrospective comparisons with younger patients. The objective of this study was to compare efficacy of abatacept in older vs. younger patients with RA, and efficacy of abatacept with that of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) in both age groups. METHODS This prospective, multicenter, observational study (UMIN000014913) enrolled csDMARD-refractory patients without previous biological DMARD treatment. Abatacept (A) or csDMARDs (C) were administered at the treating physician's discretion to older (O, ≥ 65 years) and younger (Y, 20-64 years) patients, producing AO, AY, CO, and CY groups. Clinical efficacy after 24 weeks was evaluated using European League Against Rheumatism (EULAR) erythrocyte sedimentation rate response criteria. RESULTS Overall, 202 patients were evaluated. Compared with the CO group, more patients in the AO group achieved a EULAR good or moderate response (p < 0.0001). Compared with the CY group, more patients in the AY group achieved a EULAR good or moderate response (p < 0.01). Similar proportions of patients in the AO and AY groups achieved a EULAR good response or a good or moderate response. Few adverse events were reported. CONCLUSIONS This prospective study demonstrated that abatacept is efficacious and safe in older patients with RA and a history of being refractory to csDMARDs. Abatacept was shown to be more efficacious than adding or switching to a new csDMARD in both younger and older csDMARD-refractory patients with RA. TRIAL REGISTRATION UMIN000014913.
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Ke Y, Dai X, Xu D, Liang J, Yu Y, Cao H, Chen W, Lin J. Features and Outcomes of Elderly Rheumatoid Arthritis: Does the Age of Onset Matter? A Comparative Study From a Single Center in China. Rheumatol Ther 2021; 8:243-254. [PMID: 33315188 PMCID: PMC7991049 DOI: 10.1007/s40744-020-00267-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/28/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The aim of this work is to investigate the clinical and radiological characteristics of elderly rheumatoid arthritis and compare the outcomes between the two subgroups, elderly- and young-onset rheumatoid arthritis (EORA and YORA, respectively). METHODS We conducted a retrospective case-control study on the elderly rheumatoid arthritis patients in our medical center. EORA was defined as the patient whose onset age was above 60. RESULTS A total of 142 elderly rheumatoid arthritis patients were admitted, with 79 patients in EORA and 63 in YORA group. Inflammatory parameters including C-reactive protein, D-dimer, serum ferritin, and platelet count levels were all higher in the EORA group than those in YORA. EORA patients showed a higher score of health assessment questionnaire's disability index (p = 0.01) and patient global health assessment (p = 0.049), but a lower status of modified total sharp score (p = 0.001). Bivariate logistic regression analysis revealed that elderly onset of the disease (OR 2.30, 95% CI [1.45-3.77]), age (OR 2.04, 95% CI [1.22-3.41]), high disease activity (OR 1.90, 95% CI [1.17-3.32]), and red blood cell distribution width (OR 1.81, 95% CI [1.03-3.19]) were independent prognostic factors of disability. Age (OR 0.25, 95% CI [0.07-0.91]), disease duration (OR 2.73, 95% CI [0.97-7.70]), and co-morbid diabetes mellitus (OR 118.10, 95% CI [3. 50-3985.57]) independently contributed to radiographic joint damage in the elderly population. EORA patients showed increased death incidents and worse prognosis than YORA. Cox regression analysis reveals that comorbid hypertension (HR 12.02, 95% CI [1.08-133.54]), interstitial lung disease (ILD) (HR 85.04, 95% CI [4.11-1759.19]), and compressive fracture (HR 85.04, 95% CI [4.11-1759.19]) are independent predictors of mortality, and that ILD (HR 50.21, 95% CI [5.56-335.33]) and pulmonary hypertension (HR 25.37, 95% CI [3.03-265.81]) are independent predictors of no disease remission in the EORA patients. CONCLUSIONS The distinct features of EORA patients make EORA a unique entity different from "classic rheumatoid arthritis". EORA patients develop an upgraded systemic inflammatory status, more declined life quality, and worse prognosis than the elderly YORA. Better control of the comorbidities like ILD and diabetes mellitus may benefit the management of elderly rheumatoid arthritis. Further investigation regarding the pathogenesis and therapeutic strategies of EORA is urgently warranted.
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Affiliation(s)
- Yini Ke
- Department of Rheumatology and Immunology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaona Dai
- Department of Rheumatology, Zhejiang Hospital, Hangzhou, China
| | - Danyi Xu
- Department of Rheumatology and Immunology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Junyu Liang
- Department of Rheumatology and Immunology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ye Yu
- Department of Rheumatology and Immunology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Heng Cao
- Department of Rheumatology and Immunology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Weiqian Chen
- Department of Rheumatology and Immunology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
| | - Jin Lin
- Department of Rheumatology and Immunology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Kumagai K, Okumura N, Amano Y, Yayama T, Mimura T, Maeda T, Kubo M, Mori K, Barrett-Jolley R, Imai S. Consideration of differences in drug usage between young-onset and elderly-onset rheumatoid arthritis with target of low disease activity. Mod Rheumatol 2021; 31:1094-1099. [PMID: 33538619 DOI: 10.1080/14397595.2021.1883251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Elderly-onset rheumatoid arthritis (EORA) is reported to differ from young-onset rheumatoid arthritis (YORA) with regard to patient background and drug treatment. We examined the amount of drug administered to patients who achieved low disease activity (LDA) for rheumatoid arthritis at our hospital. METHODS Demographics, clinical history, and treatments were compared between patients with EORA (n = 70) and YORA (n = 190). RESULTS There was a significant difference in the average age (73.8 vs. 57.8 years), disease duration (6.66 vs. 14.7 years), and sex (62.9% males vs. 83.7% females), but no difference in rheumatoid factor positivity (85.3% vs. 80.7%), anti-citrullinated peptide antibody positivity (86.5% vs. 87.7%), simplified disease activity index (4.28 vs. 4.59), or disease activity score 28-CRP (1.99 vs. 2.04) in the EORA and YORA groups, respectively. There were also no significant differences in prednisolone use (37.1% vs. 36.3%), amount of methotrexate administered (MTX) (1.45 vs. 1.41 mg), and MTX use (55.7% vs. 65.3%). However, the MTX dose (2.89 vs. 4.09 mg/week, p = .011) and overall biologics use (32.9% vs. 56.3%, p = .0012) were significantly lower in patients with EORA than in those with YORA. CONCLUSION Patients with EORA may be able to achieve LDA with lower drug dosage than those with YORA.
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Affiliation(s)
- Kosuke Kumagai
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Noriaki Okumura
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan.,Department of Orthopaedics, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
| | - Yasutaka Amano
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Takafumi Yayama
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Tomohiro Mimura
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Tsutomu Maeda
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Mitsuhiko Kubo
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Kanji Mori
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Richard Barrett-Jolley
- Institute of Ageing and Chronic Disease, Musculoskeletal Biology II, University of Liverpool, Liverpool, UK
| | - Shinji Imai
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan
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21
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Mathieu S, Pereira B, Saraux A, Richez C, Combe B, Soubrier M. Disease-modifying drug retention rate according to patient age in patients with early rheumatoid arthritis: analysis of the ESPOIR cohort. Rheumatol Int 2021; 41:879-885. [PMID: 33433729 DOI: 10.1007/s00296-020-04770-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
Physicians are sometimes hesitant to use disease-modifying antirheumatic drugs (DMARDs) in elderly patients with rheumatoid arthritis (RA), as they are deemed too fragile, although there are no sufficient scientific evidence. We aimed to compare DMARD treatment retention in early RA patients from the ESPOIR cohort, according to age upon inclusion. Overall, treatment retention was evaluated as the percentage of patients whose DMARDs were not stopped, with stratification by age group: < 50, 50-64, and > 65 years. Survival curves were measured using the Kaplan-Meier method. Of the entire ESPOIR cohort (n = 813), 7% were > 65 years old. Methotrexate (MTX) was used by 521 patients, and was the sole DMARD for 198 patients. MTX treatment retention appeared better in patients > 65 years old compared to < 50 years old [HR 0.45 (0.25; 0.81); p = 0.008, n = 195/198] with adjustment on sex, smoking, positive anti-cyclic citrullinated peptide antibodies, positive rheumatoid factor, body mass index, changes in DAS28 and corticosteroid treatment. The proportion of patients using etanercept (n = 111), and this drug's retention rate, did not differ according to patient age. The proportion of patients treated with adalimumab (n = 104) was significantly higher in patients < 50 years old (p = 0.003), and treatment retention was marginally better among younger patients [HR 1.68 (0.88; 3.22), p = 0.12]. Within the ESPOIR cohort, DMARD retention did not appear to differ according to age-except for better retention of MTX treatment in patients 50-64 years old, and of adalimumab in patients < 50 years old.
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Affiliation(s)
- S Mathieu
- Rheumatology Department, CHU Gabriel Montpied, Clermont 1 University, Clermont-Ferrand, France.
| | - B Pereira
- Department of Clinical Research and Innovation (DRCI), University Hospital of Clermont-Ferrand (CHU), Clermont-Ferrand, France
| | - A Saraux
- Department of Rheumatology, Brest University Hospital, Brest, France
| | - C Richez
- Rheumatology Department, CHU Pellegrin, Bordeaux, France
| | - B Combe
- Département de Rhumatologie, CHU Montpellier, Université de Montpellier, Montpellier, France
| | - M Soubrier
- Rheumatology Department, CHU Gabriel Montpied, Clermont 1 University, Clermont-Ferrand, France
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22
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Sugihara T, Ishizaki T, Onoguchi W, Baba H, Matsumoto T, Iga S, Kubo K, Kamiya M, Hirano F, Hosoya T, Miyasaka N, Harigai M. Effectiveness and safety of treat-to-target strategy in elderly-onset rheumatoid arthritis: a 3-year prospective observational study. Rheumatology (Oxford) 2021; 60:4252-4261. [DOI: 10.1093/rheumatology/keaa922] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/06/2020] [Indexed: 01/18/2023] Open
Abstract
Abstract
Objectives
To evaluate 3-year outcomes of following a treat-to-target (T2T) strategy targeting low disease activity for patients with elderly-onset RA (EORA) and to confirm safety profile of T2T.
Methods
Treatment was adjusted to target low disease activity with conventional synthetic DMARDs, followed by biologic DMARDs (bDMARDs) in 197 MTX-naïve EORA patients (mean age 74.9 years) with moderate-to-high disease activity. Non-implementation of T2T was evaluated at week 12, 24, 36, 52, 76, 104 and 128. To evaluate risks of using MTX, bDMARDs and glucocorticoids, 2122 periods of 3 months each were analysed using Bayesian hierarchical logistic regression models.
Results
Of the patients, 84.7% received methotrexate, 34.0% glucocorticoids with DMARDs and 41.6% bDMARDs during the observation period. Sixty-nine of the 197 patients failed to adhere to T2T because of comorbidities or the patient’s own decision: 33 failed once, 19 twice, 10 three times and 6 four times or more. Simplified disease activity index (SDAI) remission and HAQ Disability Index (HAQ-DI) ≤0.5 at 3 years were achieved in 57.8% and 70.3% of the 128 patients adhering to T2T, and 34.8% and 43.5% of the 69 patients who did not adhere to T2T, respectively, and these were significantly different. Eighty-nine serious adverse events (SAEs) of any type were reported in 61 patients. MTX, bDMARDs and glucocorticoid were not associated with SAEs when adjusted for mean SDAI during the observation period and comorbidities at baseline.
Conclusion
T2T strategy for EORA by using MTX and bDMARDs was effective with an acceptable safety profile. Adhering to T2T led to better outcomes.
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Affiliation(s)
- Takahiko Sugihara
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology
| | | | - Hiroyuki Baba
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Takumi Matsumoto
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Shoko Iga
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital
| | - Kanae Kubo
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital
| | - Mari Kamiya
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Fumio Hirano
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Tadashi Hosoya
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Nobuyuki Miyasaka
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Masayoshi Harigai
- Department of Rheumatology, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
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23
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Ikari Y, Yajima N, Miwa Y. The association between age and adverse events due to biologic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: A retrospective cohort study. Medicine (Baltimore) 2020; 99:e23861. [PMID: 33350780 PMCID: PMC7769304 DOI: 10.1097/md.0000000000023861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 11/21/2020] [Indexed: 01/12/2023] Open
Abstract
We examined whether the age of patients with rheumatoid arthritis was associated with adverse events (AEs) caused by biologic disease-modifying antirheumatic drugs (bDMARDs).Patients with rheumatoid arthritis using bDMARDs from Showa University Hospital, Showa University Northern Yokohama Hospital, and Showa University Koto Toyosu Hospital from January 2005 to December 2017 were eligible for this retrospective cohort study. The maximum observation period was determined to be 1 year. Outcomes in patients older and younger than 75 years were compared. The primary outcome was the rate of drug discontinuation because of AEs caused by bDMARDs. Univariate and multivariate analyses were performed using Pearson's chi-squared test and logistic regression analysis, respectively.A total of 416 patients were enrolled; median (interquartile range [IQR]): 60.0 (44.3 - 71.0) years and 84.6% women; patients ≥ 75 years were 67/416 (16.1%). The rates of drug discontinuation because of AEs caused by bDMARDs were 10.5% (7/67) in patients 75 years and older and 10.9% (38/349) in those younger than 75 years (relative risk 0.95, 95% confidential interval 0.45-2.24). In logistic regression analysis adjusted for covariates, the rate of drug discontinuation showed no significant difference between the patients ≥ 75 years and the those < 75 years (adjusted odds ratio 0.70, 95% confidential interval 0.29-1.75, P = .45).The rate of drug discontinuation because of AEs caused by bDMARDs was not significantly different between patients 75 years and older and patients younger than 75 years.
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Affiliation(s)
- Yuzo Ikari
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo
| | - Nobuyuki Yajima
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Yusuke Miwa
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo
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Alpay-Kanitez N, Pehlivan Ö, Omma A, Can-Sandikçi S, Girgin S, İçaçan OC, Çelik S, Bes C. Favorable retention rates and safety of conventional anti-rheumatic drugs in older patients with rheumatoid arthritis. Medicine (Baltimore) 2020; 99:e19696. [PMID: 32311948 PMCID: PMC7220761 DOI: 10.1097/md.0000000000019696] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Physicians are challenged by the recognition and treatment of older patients with rheumatoid arthritis (RA). The aim of this case-control study was to evaluate the retention and safety of conventional disease-modifying anti-rheumatic drugs in older patients with RA.In this observational case-control study, we assessed older patients with RA (≥65 years) who were diagnosed in 3 different rheumatology centers from Turkey. Patients were divided as to those aged ≥65 years (elderly rheumatoid arthritis [ERA]) and those aged <65 years (young rheumatoid arthritis [YRA]) at the time of conventional DMARD treatment initiation. The Mann-Whitney U test was used for the comparison of 2 non-normally distributed groups. The Chi-square (χ) test was used for categorical variables. Survival analysis were performed using the Kaplan-Meier method.Four hundred eighteen patients with RA (296 females [71%]) were included from January 2010 to January 2018. The age of treatment onset of 190 (47%) patients was in the elderly period and they were included in the ERA group. In the analysis of drug retention rates, there was no significant difference between the ERA and YRA groups for each conventional DMARD (methotrexate 71.2% in ERA, 62.7% in YRA, P = .817; hydroxychloroquine 82.9% in ERA, 78.8% in YRA, P = .899; leflunomide 81.4% in ERA, 84.4% in YRA, P = .205; sulfasalazine 37.5% in ERA, 40.9% in YRA, P = .380). The adverse event data were also similar in both groups.The drug retention and adverse effect rates in older patients with RA using conventional DMARDS are similar to the rates in young patients with RA.
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Affiliation(s)
- Nilüfer Alpay-Kanitez
- Department of Internal Medicine, Division of Rheumatology, Koç University School of Medicine, Health Sciences University
| | - Özlem Pehlivan
- Department of Internal Medicine, Division of Rheumatology, Ümraniye Training and Research Hospital, Health Sciences University, Istanbul
| | - Ahmet Omma
- Department of Internal Medicine, Division of Rheumatology, Ankara Numune Training and Research Hospital, Health Sciences University, Ankara
| | - Sevinç Can-Sandikçi
- Department of Internal Medicine, Division of Rheumatology, Ankara Numune Training and Research Hospital, Health Sciences University, Ankara
| | - Sinem Girgin
- Department of Internal Medicine, Division of Rheumatology, Bakirköy Dr. Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Ozan Cemal İçaçan
- Department of Internal Medicine, Division of Rheumatology, Bakirköy Dr. Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Selda Çelik
- Department of Internal Medicine, Division of Rheumatology, Bakirköy Dr. Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Cemal Bes
- Department of Internal Medicine, Division of Rheumatology, Bakirköy Dr. Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey
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Yoshii I, Chijiwa T, Sawada N. Efficacy and Safety of Targeted Strategy for Treating Rheumatoid Arthritis Patients Aged 75 Years or Older. TOHOKU J EXP MED 2020; 250:13-23. [DOI: 10.1620/tjem.250.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ichiro Yoshii
- Department of Rheumatology and Musculoskeletal Medicine, Yoshii Hospital
| | | | - Naoya Sawada
- Department of Rheumatology, Dohgo Onsen Hospital
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Yoshii I, Chijiwa T, Sawada N. Validity of adopting a Health Assessment Questionnaire Disability Index less than 0.5 as a target in elderly rheumatoid arthritis patients. Clin Rheumatol 2019; 38:3351-3360. [PMID: 31372851 DOI: 10.1007/s10067-019-04692-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/28/2019] [Accepted: 07/10/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The effect of age on the Health Assessment Questionnaire Disability Index (HAQ-DI) scores of rheumatoid arthritis (RA) patients and the validity of adopting HAQ-DI < 0.5 as the target for functional remission and comprehensive disease control (CDC) under a treat-to-target (T2T) treatment strategy were investigated. METHOD A total of 441 RA patients with > 3-year treatment under T2T were evaluated. The relationships between the HAQ-DI score at follow-up (HAQ) and 28-joint Disease Activity Score with C-reactive protein, Sharp/van der Heijde Score, age at follow-up, and HAQ-DI at baseline were statistically evaluated with best subset regression analysis in groups separated according to age and the EULAR response. CDC status was evaluated with a chi-square test. RESULTS The HAQ score significantly correlated with all indices in the group ≥ 65 years old (G-O) and in the group with good or moderate EULAR responses (p < 0.01). No significant correlation was observed in the group < 65 years old (G-Y) or in the group with no EULAR response. The CDC ratio was not significantly different between the age groups, whereas the HAQ failure ratio was significantly greater in G-O than in G-Y (p < 0.01). No significant difference was found between the EULAR response groups. CONCLUSIONS The HAQ score is influenced by age in patients > 65 years. T2T is appropriate for attaining good disease activity control but does not always lead to functional remission in these patients. The HAQ score < 0.5 is not an appropriate target for functional remission according to the CDC criteria for elderly patients.Key Points• ADL in elderly RA patient aged ≥ 65 years declines corresponding to his/her aging.• Functional remission for elderly RA patients is not the same as that for young RA patients.• The HAQ score < 0.5 in elderly RA patient is not an appropriate target for CDC.
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Affiliation(s)
- Ichiro Yoshii
- Department of Rheumatology and Musculoskeletal Medicine, Yoshii Hospital, 6-7-5 Nakamura-Ohashidori, Shimanto City, Kochi Prefecture, 787-0033, Japan.
| | - Tatsumi Chijiwa
- Department of Rheumatology, Kochi Memorial Hospital, Kochi, Japan
| | - Naoya Sawada
- Department of Rheumatology, Dohgo Onsen Hospital, Matsuyama, Japan
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Mochizuki T, Ikari K, Yano K, Okazaki K. Five-year incidence of common comorbidities, such as hypertension, dyslipidemia, diabetes mellitus, cardiovascular disease, cerebrovascular disease and cancer, in older Japanese patients with rheumatoid arthritis. Geriatr Gerontol Int 2019; 19:577-581. [PMID: 30950139 DOI: 10.1111/ggi.13664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/27/2019] [Accepted: 03/08/2019] [Indexed: 11/29/2022]
Abstract
AIM To estimate the 5-year incidence of common comorbidities, including lifestyle-associated diseases, in older Japanese patients with rheumatoid arthritis (RA). METHODS We enrolled 129 consecutive patients with RA aged ≥65 years in this study. We examined all patients for the presence of hypertension, dyslipidemia, diabetes mellitus, cardiovascular disease, cerebrovascular disease and cancer at baseline (in 2013) and 5 years later (in 2018) using clinical records, self-reported questionnaires, interviews and medication records. RESULTS At baseline, hypertension was prevalent in 37.2% of the patients, dyslipidemia in 18.6%, diabetes mellitus in 9.3%, cardiovascular disease in 14.7%, cerebrovascular disease in 10.1% and cancer in 10.1%. Furthermore, the change of prevalence after 5 years from baseline of hypertension, dyslipidemia, diabetes mellitus, cardiovascular disease, cerebrovascular disease and cancer was 4.6%, 3.9%, 0.8%, 4.7%, 2.3% and 1.5%, respectively. The factors associated at baseline and/or after 5 years of hypertension, dyslipidemia, diabetes mellitus, cardiovascular disease and cancer included disease duration and body mass index, body mass index and anti-cyclic citrullinated peptide antibody, corticosteroid use, body mass index, and male and disease duration, respectively. CONCLUSIONS The Japanese population is aging and so is the population of patients with RA. In older patients with RA, hypertension and cardiovascular disease should be particularly considered. Therefore, although the therapeutic agents for RA have improved, a better understanding of the comorbidities in older patients with RA should impact the treatment of RA. Geriatr Gerontol Int 2019; 19: 577-581.
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Affiliation(s)
- Takeshi Mochizuki
- Department of Orthopedic Surgery and Rheumatology, Kamagaya General Hospital, Chiba, Japan
| | - Katsunori Ikari
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichiro Yano
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Okazaki
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Murata K, Ito H, Hashimoto M, Nishitani K, Murakami K, Tanaka M, Yamamoto W, Mimori T, Matsuda S. Elderly onset of early rheumatoid arthritis is a risk factor for bone erosions, refractory to treatment: KURAMA cohort. Int J Rheum Dis 2018; 22:1084-1093. [PMID: 30415498 DOI: 10.1111/1756-185x.13428] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/31/2018] [Accepted: 10/04/2018] [Indexed: 01/23/2023]
Abstract
AIM Age at disease onset has been implicated as an indicator of disease activity and severity in rheumatoid arthritis (RA). This study aimed to investigate how old age at disease onset affects patient treatment and prognosis in early RA. METHODS Data from the Kyoto University Rheumatoid Arthritis Management Alliance (KURAMA) cohort was analyzed. From 2011 to 2015, a total of 2182 patients with RA were enrolled in the cohort; 239 patients were newly diagnosed with RA and were followed up for 2 years. The patients were divided into the following two groups: the young-onset RA (YORA) which included patients <60 years old (n = 117) and elderly-onset RA (EORA) which comprised patients ≥60 years old (n = 122). The clinical and laboratory data were compared at baseline, at 1 year, and at 2 years after onset. RESULTS Disease activity was higher in EORA than in YORA at baseline. Although disease activity was equivalent between EORA and YORA at 1 or 2 years, more EORA patients had bone erosions at baseline and at 2 years. More than 25% of the anti-citrullinated protein autoantibody (ACPA)-positive EORA patients without erosions at baseline had bone erosions even if they attained clinical remission at 1 or 2 years, while ~10% of YORA patients had erosions. CONCLUSION Bone erosions were more frequently found in EORA. Clinical remission at 1 or 2 years was not enough to protect bone erosions in the ACPA-positive EORA patients. Optimal treatment strategies preventing radiological damage should be considered for EORA.
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Affiliation(s)
- Koichi Murata
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Motomu Hashimoto
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kohei Nishitani
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kosaku Murakami
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masao Tanaka
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Wataru Yamamoto
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Health Information Management, Kurashiki Sweet Hospital, Kurashiki, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Oishi S, Wendling D, Sibilia J, Job-Deslandre C, Guillevin L, Benichou J, Flipo RM, Duquenne C, Guillemin F, Saraux A. Treatment of active rheumatoid arthritis: comparison of patients younger vs older than 75 years (CORPUS cohort). Hum Vaccin Immunother 2018; 14:2612-2617. [PMID: 30230962 PMCID: PMC6314403 DOI: 10.1080/21645515.2018.1522470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objectives: Little information is available on the characteristics of elderly patients starting TNFα antagonist treatment for rheumatoid arthritis (RA). The objective of this work was to compare prescription patterns in RA patients younger vs. older than 75 years. Methods: Biologic-naive patients with active RA (DAS28 > 3.2) despite first-line therapy were included between 2007 and 2009 in the prospective, multicentre, longitudinal, observational, population-based CORPUS-RA cohort. TNFα antagonist users were defined as having received at least one TNFα antagonist during the first study year. The groups < 75 years and ≥ 75 years were compared regarding comorbidities, inflammation (CRP and ESR), disease activity (DAS28), disability (HAQ-DI), number of physician visits, and treatment. To verify the impact of the cut off, we also compared patients aged 70 years or more to patients younger than 70 years. Results: Of 543 RA patients, 382 had complete one-year follow-up data, including 114 TNFα antagonist users, 3 (6%) among the 49 patients aged 75 years or over and 111 (32%) of the 333 patients younger than 75 years (p < 0.01). Disease activity in the two age groups was similar at inclusion and after one year. Comorbidities and a history of auto-immunity were more common in the older group. Compared to their younger counterparts, the older patients received glucocorticoids more often (p = 0.003) and synthetic disease-modifying anti-rheumatic drugs less often (p = 0.01). Conclusion: TNFα antagonists are used less often and glucocorticoids more often in elderly patients with active RA compared to their younger counterparts. The fact that this study was performed in 2007–9 is a limitation in terms of relevance to today’s patients and further studies should be conducted in new cohorts of active RA.
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Affiliation(s)
- Sachiyo Oishi
- a Rheumatology department , Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU Brest , Brest Cedex , France
| | - Daniel Wendling
- b Rheumatology department , Besançon University Hospital, Boulevard Fleming , Besançon , France.,c EA 4266 , Franche-Comté University , Besançon , France
| | - Jean Sibilia
- d Rheumatology department , Hautepierre University Hospital , Strasbourg , France
| | | | - Loic Guillevin
- f Department of Internal Medicine , Cochin-Paris University Hospital , Paris , France
| | - Jacques Benichou
- g Department of Biostatistics and Clinical Research , Rouen University Hospital , Rouen , France.,h INSERM U1219 , University of Rouen , Rouen , France
| | - René Marc Flipo
- i Rheumatology department , Lille University Hospital , Lille , France
| | - Carole Duquenne
- a Rheumatology department , Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU Brest , Brest Cedex , France
| | - Francis Guillemin
- j INSERM, CIC-EC 1433 , Université de Lorraine, Brabois University Hospital , Vandoeuvre-lès-Nancy , France
| | - Alain Saraux
- k Rheumatology department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex 'Immunotherapy, Graft, Oncology' , Université de Brest , Brest , Cedex , France
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30
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Morita Y, Ito H, Torii M, Hanai A, Furu M, Hashimoto M, Tanaka M, Azukizawa M, Arai H, Mimori T, Matsuda S. Factors affecting walking ability in female patients with rheumatoid arthritis. PLoS One 2018; 13:e0195059. [PMID: 29584787 PMCID: PMC5870996 DOI: 10.1371/journal.pone.0195059] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/15/2018] [Indexed: 11/23/2022] Open
Abstract
Objective To determine the factors associated with gait parameters in female patients with rheumatoid arthritis (RA). Methods The gait analysis was performed in a large cohort of RA patients, and three basic gait parameters (step length, cadence and gait speed) were calculated. Clinical and laboratory data were also collected. Factors associated with gait parameters were analyzed using multivariable linear regression in the three models with forced entry. Then, we divided those patients with Health Assessment Questionnaire disability index (HAQ) scores ≤ 0.5 into two groups according to their gait speed that were compared to identify the characteristics of patients with a good HAQ score but poor walking ability. Results A total of 318 female patients were analyzed. Knee extension strength had the strongest positive association with all three gait parameters (P < 0.0001), while methotrexate use was also positively associated with all three gait parameters (step length: P < 0.05, cadence: P < 0.05 in model 1 and 2; P < 0.01 in model 3, gait speed: P < 0.01). The disease activity score was negatively associated with step length and gait speed (step length, gait speed: P < 0.01 in model 1 and 2; P < 0.05 in model 3). 26% of patients with good HAQ scores showed slow gait speed. Patients with good HAQ scores and slow gait speed had higher disease activity scores (P < 0.05) and lower knee extension strength (P < 0.0001) than those with good HAQ scores and normal gait speed. Conclusions High knee extension strength, low disease activity and administration of methotrexate were strongly associated with good walking ability in female patients with RA. And, even if patients showed good HAQ scores, about quarter of those patients had poor walking ability, and they showed higher disease activity, lower knee extension strength, compared to the patients with normal gait speed.
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Affiliation(s)
- Yugo Morita
- The Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiromu Ito
- The Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- * E-mail:
| | - Mie Torii
- The Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akiko Hanai
- The Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Moritoshi Furu
- The Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- The Department of the Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Motomu Hashimoto
- The Department of the Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masao Tanaka
- The Department of the Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masayuki Azukizawa
- The Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Tsuneyo Mimori
- The Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- The Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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31
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Takai C, Kobayashi D, Ito S, Murasawa A, Wada Y, Narita I, Nakazono K. [The treatment of patients with elderly-onset rheumatoid arthritis at Niigata Rheumatic Center]. Nihon Ronen Igakkai Zasshi 2018; 55:251-258. [PMID: 29780094 DOI: 10.3143/geriatrics.55.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To investigate the clinical course of patients with elderly-onset rheumatoid arthritis (RA). METHODS We compared the characteristics, and clinical course of 55 patients who developed RA at over 80 years of age (elderly-onset [EO] group) with 119 patients who developed RA at 40-59 years of age (non-elderly onset [non-EO] group). We also investigated the characteristics and clinical course of 19 patients who developed RA at over 80 and who received biological disease-modifying anti-rheumatic drugs (bDMARDs). RESULTS The mean DAS28-ESR (DAS) and HAQ-DI (HAQ) of the EO were significantly higher in comparison to the non-EO group (4.91±1.31 vs 4.41±1.47, p=0.043, 1.2±0.9 vs 0.5±0.6, p<0.01). For the first treatment, 87.3% in the EO group received conventional synthetic DMARDs (csDMARDs), none received MTX. The rate of prednisolone (PSL) administration in the EO group was significantly higher than the non-EO group (56.4% vs 30.3%, p<0.01). The DAS and HAQ were significantly decreased in both groups, while the HAQ of the EO group was higher than the non-EO group. The decrease in DAS and HAQ of the PSL users was significantly greater than the non-PSL users (ΔDAS: 2.55±1.83 vs 1.83±1.23, p<0.01, ΔHAQ: 0.9±1.0 vs 0.3±0.6, p=0.027). Among the 19 patients with bDMARDs, the mean DAS and HAQ at baseline were significantly decreased 6 months later. CONCLUSION Early use of csDMARDs and PSL was effective for functional disability of elderly-onset RA; however, some of them required bDMARDs. Further study should be performed to investigate the effectiveness of the early induction of MTX and bDMARDs.
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Affiliation(s)
- Chinatsu Takai
- Department of Rheumatology, Niigata Rheumatic Center
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences
| | - Daisuke Kobayashi
- Department of Rheumatology, Niigata Rheumatic Center
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences
| | - Satoshi Ito
- Department of Rheumatology, Niigata Rheumatic Center
| | | | - Yoko Wada
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences
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Safety and Efficacy of Biological Disease-Modifying Antirheumatic Drugs in Older Rheumatoid Arthritis Patients: Staying the Distance. Drugs Aging 2017; 33:387-98. [PMID: 27154398 DOI: 10.1007/s40266-016-0374-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The population of older individuals with rheumatoid arthritis (RA) is rapidly expanding, mainly due to increased life expectancy. While targeted biological therapies are well established for the treatment of this disease, their use may be lower in older patients (age > 65 years) and very old patients (age > 75 years) as a result of perceived higher risks for adverse events in this population, taking into account comorbidity, polypharmacy, and frailty. In this review, we discuss the available evidence for the use of biological therapies in this growing patient group with specific attention towards the eventual reasons for biological treatment failure or withdrawal. The majority of data is found in secondary analyses of clinical trials and in retrospective cohorts. The most information available is on tumor necrosis factor (TNF) blockers. Older patients seem to have a less robust response to anti-TNF agents than a younger population, but drug survival as a proxy for efficacy does not seem to be influenced by age. Despite an overall rate of adverse effects comparable to that in younger patients, older RA patients are at higher risk of serious infections. Other biologics appear to have an efficacy similar to anti-TNF agents, also in older RA patients. Again, the drug survival rates for tocilizumab, rituximab, and abatacept resemble those in young RA patients with good general tolerability and safety profiles. The cardiovascular risk and the risk of cancer, increased in RA patients and in the older RA patients, do not appear to be strongly influenced by biologicals.
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Zhang L, Wang J, Zhang Q, Fu T, Yin R, Wang Z, Li L, Wu X, Gu Z. Factors associated with hand joint destruction in Chinese patients with rheumatoid arthritis. BMC Musculoskelet Disord 2017; 18:211. [PMID: 28532395 PMCID: PMC5440941 DOI: 10.1186/s12891-017-1548-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/04/2017] [Indexed: 01/09/2023] Open
Abstract
Background There have been no previous report of hand joint destruction prevalence in Chinese rheumatoid arthritis (RA) patients. Therefore, the aim of this study was to investigate the prevalence and potential factors of hand joint destruction among RA patients from Nantong China. In addition, we wanted to examine the differences between functional capacity, psychological status, and quality of life in patients with hand joint destruction compared to those without hand joint destruction. Methods A cross-sectional study was conducted from the Affiliated Hospital of Nantong University between July 2015 and June 2016. RA patients completed questionnaires for demographic or clinical variables, the 10-cm Visual Analog Scale for pain, the 28-joint Disease Activity Score-erythrocyte sedimentation rate for disease activity, the Health Assessment Questionnaire-disability index for physical function, the Hospital Anxiety and Depression Scale for anxiety and depression, and the Short Form 36 health survey for quality of life. Laboratory examinations were taken to obtain some biochemical indicators (e.g., rheumatoid factor, anti-cyclic citrullinated peptide antibody). X-ray assessment of hand was performed and hand joint destruction was defined as Sharp score > 0. Independent sample t-test, Mann–Whitney U-test, Chi-square test, and multivariate analysis using backward stepwise logistic regression model were used to analyze these data. Results One hundred and sixty-one RA patients were included in this study. Radiographic findings revealed that almost 47.2% (n = 76) of patients had hand joint destruction. Multivariate analysis found that education ≤ 9 years (p = 0.041), anti-cyclic citrullinated peptide antibody positive (p = 0.021), high disease activity (p = 0.020), and long disease duration (p < 0.001) were important potential risk factors of hand joint destruction. Participants with hand joint destruction tended to have lower physical function and quality of life, and more severe depressive symptoms compared to individuals without hand joint destruction. Conclusions 47.2% of people with RA from Nantong China experienced hand joint destruction. Education, anti-cyclic citrullinated peptide antibody, disease activity, and disease duration had great impacts on hand joint destruction. The results suggested that rheumatologists should pay attention to RA patients’ hand joint destruction, especially those with low education levels, anti-cyclic citrullinated peptide antibody positive, high disease activity, and long disease duration by patient education or other ways to improve patients’ prognosis.
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Affiliation(s)
- Lijuan Zhang
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China.,School of Nursing, Nantong University, 19th Qixiu Road, 226001, Nantong, People's Republic of China
| | - Jing Wang
- Department of Medical Image, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China
| | - Qiuxiang Zhang
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China.,School of Nursing, Nantong University, 19th Qixiu Road, 226001, Nantong, People's Republic of China
| | - Ting Fu
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China.,School of Nursing, Nantong University, 19th Qixiu Road, 226001, Nantong, People's Republic of China
| | - Rulan Yin
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China.,School of Nursing, Nantong University, 19th Qixiu Road, 226001, Nantong, People's Republic of China
| | - Ze Wang
- Department of Medical Image, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China
| | - Liren Li
- School of Nursing, Nantong University, 19th Qixiu Road, 226001, Nantong, People's Republic of China
| | - Xianhua Wu
- Department of Medical Image, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China.
| | - Zhifeng Gu
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001, Nantong, People's Republic of China.
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Kato E, Sawada T, Tahara K, Hayashi H, Tago M, Mori H, Nishino J, Matsui T, Tohma S. The age at onset of rheumatoid arthritis is increasing in Japan: a nationwide database study. Int J Rheum Dis 2017; 20:839-845. [PMID: 28205423 DOI: 10.1111/1756-185x.12998] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To determine whether the age at onset of rheumatoid arthritis (RA) has increased in Japan using a nationwide database (National Database of Rheumatic Diseases by iR-net in Japan, NinJa). METHOD We analyzed the data of RA patients who had been diagnosed with early RA (disease duration < 2 years) and newly registered in 2003, 2008 or 2013. RESULTS The numbers of patients who developed RA in 2002-2003, 2007-2008, and 2012-2013 were 536, 812 and 1864, respectively. The mean age at RA onset increased significantly from 55.8 years in 2002-2003 and 57.0 years in 2007-2008 to 59.9 years in 2012-2013. The peak age shifted from the 50-59 years age group in 2002-2003 to the 60-69 years age group in 2012-2013. There was no apparent difference in the age at RA onset between male and female RA patients. Notably, in the period 2002-2003, the prevalence of RA was markedly higher in the age group of 50-59 years, which included the first 'baby boomers', than in the age groups of 30-39 and 40-49 years, even with consideration of the variations in the age composition of the general population. CONCLUSIONS We have demonstrated that the age at RA onset in Japan has increased significantly over the last decade. This can be attributed to Japan's aging population. In addition, the high prevalence of RA among the first baby boomers suggests that environmental factors might also have contributed to the increase in age at RA onset in Japan.
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Affiliation(s)
- Eri Kato
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Tetsuji Sawada
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Koichiro Tahara
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Haeru Hayashi
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Mayu Tago
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Hiroaki Mori
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Jinju Nishino
- Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology, Sagamihara Hospital, National Hospital Organization, Sagamihara, Kanagawa, Japan
| | - Toshihiro Matsui
- Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigeto Tohma
- Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology, Sagamihara Hospital, National Hospital Organization, Sagamihara, Kanagawa, Japan
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Chakr RMDS, Brenol C, Ranzolin A, Bernardes A, Dalosto AP, Ferrari G, Scalco S, Olszewski V, Kohem C, Monticielo O, Brenol JCT, Xavier RM. Rheumatoid arthritis seems to have DMARD treatment decision influenced by fibromyalgia. REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57:403-411. [PMID: 29037312 DOI: 10.1016/j.rbre.2017.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To compare DMARD use in patients with and without FM over time, including overtreatment and undertreatment rates in both groups. METHODS A prospective cohort study with patients attending an RA outpatient clinic was conducted. Participants were consecutively recruited between March 2006 and June 2007 and were followed through December 2013. Data on DMARD use (prevalences, doses and escalation rates), DAS28, HAQ and radiographic progression were compared among RA patients with FM and without FM. Mistreatment clinical scenarios were allegedly identified and compared between groups. RESULTS 256 RA patients (32 with FM) were followed for 6.2±2.0 (mean±SD) years comprising 2986 visits. At baseline, RA duration was 11.1±7.4 years. DAS28 and HAQ were greater in RA with FM group, and were closer to RA without FM group towards the end. RA patients with FM used higher doses of tricyclic antidepressants, leflunomide and prednisone, and lower doses of methotrexate. When compared to RA patients without FM, participants with RA and FM used more often tricyclic antidepressants, leflunomide, prednisone, continuous analgesics and less often methotrexate. Groups presented similar 7-year biologic-free survival, and radiographic progression-free survival in Cox regression. RA patients with FM had greater proportions of visits in mistreatment scenarios when compared to RA patients without FM (28.4 vs. 19.8%, p<0.001). CONCLUSIONS RA patients with FM used more leflunomide and prednisone, and RA mistreatment was more frequent in FM patients. Certainly, RA patients with FM will benefit from a personalized T2T strategy, including ultrasound (when suitable) and proper FM treatment.
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Affiliation(s)
| | - Claiton Brenol
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Aline Ranzolin
- Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Amanda Bernardes
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ana Paula Dalosto
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Giovani Ferrari
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Stephanie Scalco
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Vanessa Olszewski
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Charles Kohem
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Odirlei Monticielo
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | - Ricardo M Xavier
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Chakr RMDS, Brenol C, Ranzolin A, Bernardes A, Dalosto AP, Ferrari G, Scalco S, Olszewski V, Kohem C, Monticielo O, Brenol JCT, Xavier RM. Rheumatoid arthritis seems to have DMARD treatment decision influenced by fibromyalgia. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 57:S0482-5004(16)30173-5. [PMID: 28040332 DOI: 10.1016/j.rbr.2016.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 10/12/2016] [Accepted: 11/08/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare DMARD use in patients with and without FM over time, including overtreatment and undertreatment rates in both groups. METHODS A prospective cohort study with patients attending an RA outpatient clinic was conducted. Participants were consecutively recruited between March 2006 and June 2007 and were followed through December 2013. Data on DMARD use (prevalences, doses and escalation rates), DAS28, HAQ and radiographic progression were compared among RA patients with FM and without FM. Mistreatment clinical scenarios were allegedly identified and compared between groups. RESULTS 256 RA patients (32 with FM) were followed for 6.2±2.0 (mean±SD) years comprising 2,986 visits. At baseline, RA duration was 11.1±7.4 years. DAS28 and HAQ were greater in RA with FM group, and were closer to RA without FM group towards the end. RA patients with FM used higher doses of tricyclic antidepressants, leflunomide and prednisone, and lower doses of methotrexate. When compared to RA patients without FM, participants with RA and FM used more often tricyclic antidepressants, leflunomide, prednisone, continuous analgesics and less often methotrexate. Groups presented similar 7-year biologic-free survival, and radiographic progression-free survival in Cox regression. RA patients with FM had greater proportions of visits in mistreatment scenarios when compared to RA patients without FM (28.4 vs. 19.8%, p<0.001). CONCLUSIONS RA patients with FM used more leflunomide and prednisone, and RA mistreatment was more frequent in FM patients. Certainly, RA patients with FM will benefit from a personalized T2T strategy, including ultrasound (when suitable) and proper FM treatment.
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Affiliation(s)
| | - Claiton Brenol
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - Aline Ranzolin
- Universidade Federal de Pernambuco (UFPE), Recife, PE, Brasil
| | - Amanda Bernardes
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - Ana Paula Dalosto
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - Giovani Ferrari
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - Stephanie Scalco
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - Vanessa Olszewski
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - Charles Kohem
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - Odirlei Monticielo
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | | | - Ricardo M Xavier
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
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Lemmey AB, Wilkinson TJ, Clayton RJ, Sheikh F, Whale J, Jones HSJ, Ahmad YA, Chitale S, Jones JG, Maddison PJ, O'Brien TD. Tight control of disease activity fails to improve body composition or physical function in rheumatoid arthritis patients. Rheumatology (Oxford) 2016; 55:1736-45. [PMID: 27288209 DOI: 10.1093/rheumatology/kew243] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE RA typically features rheumatoid cachexia [loss of muscle mass (MM) and excessive total fat mass (TFM), especially trunk FM], which contributes to physical disability. Since rheumatoid cachexia is driven by inflammation, it would be anticipated that the success of tight control of disease activity, such as treat-to-target (T2T), in attenuating inflammation would benefit body composition and physical function. This aim of this cross-sectional study was to assess the impact of T2T on body composition and objectively assessed function in RA patients. METHODS A total of 82 RA patients exclusively treated by T2T, were compared with 85 matched sedentary healthy controls (HCs). Body composition was estimated by DXA, with appendicular lean mass the surrogate measure of total MM. Physical function was assessed by knee extensor strength, handgrip strength, 30 s sit-to-stands, 8' up and go, and 50' walk (tests which reflect the ability to perform activities of daily living). RESULTS Although generally well treated (mean DAS28 = 2.8, with 49% in remission), RA patients had ∼10% proportionally less appendicular lean mass and were considerably fatter (by ∼27%), particularly in the trunk (∼32%), than HCs. All measures of function were 24-34% poorer in the RA patients relative to HC. CONCLUSIONS Despite marked improvements in disease control (most patients achieving or approaching remission), the relative loss of MM and increased adiposity in RA patients compared with matched HCs was similar to that observed pre-T2T. Additionally, performance of objective function tests was unchanged from that reported by our group for pre-T2T RA patients. Thus T2T, even in responsive RA patients, did not attenuate rheumatoid cachexia or improve objectively assessed function.
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Affiliation(s)
- Andrew B Lemmey
- Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor
| | - Thomas J Wilkinson
- Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor
| | - Rebecca J Clayton
- Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor Peter Maddison Rheumatology Centre, Llandudno Hospital, Betsi Cadwaladr University Health Board, Gwynedd
| | - Fazal Sheikh
- Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor Peter Maddison Rheumatology Centre, Llandudno Hospital, Betsi Cadwaladr University Health Board, Gwynedd
| | - John Whale
- Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor
| | - Hope S J Jones
- Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor
| | - Yasmeen A Ahmad
- Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor Peter Maddison Rheumatology Centre, Llandudno Hospital, Betsi Cadwaladr University Health Board, Gwynedd
| | - Sarang Chitale
- Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor Peter Maddison Rheumatology Centre, Llandudno Hospital, Betsi Cadwaladr University Health Board, Gwynedd
| | - Jeremy G Jones
- Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor Peter Maddison Rheumatology Centre, Llandudno Hospital, Betsi Cadwaladr University Health Board, Gwynedd
| | - Peter J Maddison
- Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor Peter Maddison Rheumatology Centre, Llandudno Hospital, Betsi Cadwaladr University Health Board, Gwynedd
| | - Thomas D O'Brien
- Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor Research Institute for Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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Fiorino G, Bonifacio C, Peyrin-Biroulet L, Danese S. Preventing Collateral Damage in Crohn's Disease: The Lémann Index. J Crohns Colitis 2016; 10:495-500. [PMID: 26744441 PMCID: PMC4946759 DOI: 10.1093/ecco-jcc/jjv240] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 12/17/2015] [Indexed: 12/12/2022]
Abstract
Crohn's disease [CD] is a chronic progressive and destructive condition. Half of all CD patients will develop bowel damage at 10 years. As in rheumatic diseases, preventing the organ damage consequent to CD complications [fistula, abscess, and/or stricture] is emerging as a new therapeutic goal for these patients in clinical practice. This might be the only way to alter disease course, as surgery is often required for disease complications. Similar to the joint damage in rheumatoid arthritis, bowel damage has also emerged as a new endpoint in disease-modification trials such as the REACT trial. Recently, the Lemann Index [LI] has been developed to measure CD-related bowel damage, and to assess damage progression over time, in order to evaluate the impact of therapeutic strategies in terms of preventing bowel damage. While validation is pending, recent reports suggested that bowel damage is reversible by anti-tumour necrosis factor [TNF] therapy. The Lémann index may play a key role in CD management, and should be implemented in all upcoming disease-modification trials in CD.
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Affiliation(s)
- Gionata Fiorino
- Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | - Silvio Danese
- Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
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Sugihara T, Harigai M. Targeting Low Disease Activity in Elderly-Onset Rheumatoid Arthritis: Current and Future Roles of Biological Disease-Modifying Antirheumatic Drugs. Drugs Aging 2016; 33:97-107. [PMID: 26833350 PMCID: PMC4756046 DOI: 10.1007/s40266-015-0341-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Elderly rheumatoid arthritis (RA) is classified into two clinical subsets, elderly-onset RA (EORA) and younger-onset elderly RA. With the improvement of life expectancy in the general population and advent of the super-aging society, the number of patients with EORA is anticipated to increase. Both large and small joints are affected initially at onset, and individuals with early EORA have higher scores of disease activity and levels of acute-phase reactants than those with early younger-onset RA. EORA is a progressive disease similar to younger-onset RA. Tumor necrosis factor (TNF) inhibitors are equally or slightly less effective in elderly patients than in younger patients with RA, and disease duration may have a greater impact on disease outcomes than age. Evidence of non-TNF biological disease-modifying antirheumatic drug use in EORA is limited. TNF inhibitors may not increase the risk for infection in elderly patients any more than methotrexate; however, increasing age is an independent and strong risk factor for serious infections in patients with RA. Treatment choice in patients with EORA is strongly influenced by comorbidities, especially cardiovascular disease, chronic lung disease, and frailty. To prevent progression to irreversible geriatric syndromes, non-frail patients with EORA, who are aging successfully should undergo intensive treatment using the treat-to-target strategy, and pre-frail and frail patients with EORA should be treated with the aim of returning to a non-frail or pre-frail stage, respectively. An appropriate treatment strategy for EORA and younger-onset elderly RA should be developed in the next decade using a multi-disciplinary approach.
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Affiliation(s)
- Takahiko Sugihara
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Masayoshi Harigai
- Department of Epidemiology and Pharmacoepidemiology, Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan.
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Affiliation(s)
- Tsuyoshi TAKEDA
- Department of Internal Medicine, Japan Organization of Occupational Health and Safety, Hokkaido Spinal Cord Injury Center
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