Elderly-onset rheumatoid arthritis

Soubrier, Martin; Mathieu, Sylvain; Payet, Sarah; Dubost, Jean‐Jacques; Ristori, Jean‐Michel

doi:10.1016/j.jbspin.2010.04.004

Cited by 56 publications

(50 citation statements)

References 55 publications

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“…With the increased life expectancy and quality of life, the number of older patients with RA is steadily increasing in the Western world, representing 10-33% of all RA cases [7]. The overall prevalence of RA in older persons (≥60 years) is estimated around 2% and reaching up to 2.8% after 70 years [8].…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Biological Disease-Modifying Antirheumatic Drugs in Older Rheumatoid Arthritis Patients: Staying the Distance

Ishchenko

Lories

2016

Drugs Aging

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The population of elderly individuals with rheumatoid arthritis is rapidly expanding, mainly due to the increased life expectancy. While targeted biological therapies are well established for the treatment of this disease, their use may be lower in elderly (> of 65 years old) and very elderly patients (> 75 years old) due to perceived higher risks for adverse events in this population taking into account comorbidity, polypharmacy and frailty. In this review we discuss available evidence for the use of biological therapies in this growing patient group with specific attention towards eventual reasons for biological treatment failure or withdrawal. The majority of data is found in secondary analyses of clinical trials and in retrospective cohorts. Most information is available about 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 that may considered 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, elderly RA patients are at higher risk of serious infections. Other biologics appear to have an efficacy similar to anti-TNF agents, also in the elderly 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 patents and in the elderly patients, do not appear to be strongly influenced by biologicals. Key points-Biological drugs targeting specific cytokines or immune cell populations are an important part of the management strategy for rheumatoid arthritis patients, including the elderly. 3-Overall safety and tolerability in the elderly patients is very good and age should not be a critical factor to decide against biological drug use.-The drug survival rate of biologicals in the elderly RA patients is comparable to that in the young RA population.-Co-morbidities and risk of infection are important variables to assess when considering a biological drug in the elderly.-More data and specific studies are required to better position biological drug use in this particular population as current studies provide a low level of evidence. Data in patients above 75 years are still largely missing. Moreover, the group of elderly patients that were included in clinical trials may be influenced by selection bias at inclusion and not be fully representative for infections risks and other comorbidities.4

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Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Biological Disease-Modifying Antirheumatic Drugs in Older Rheumatoid Arthritis Patients: Staying the Distance

Ishchenko

Lories

2016

Drugs Aging

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“…Nearly 30% of patients with rheumatoid arthritis (RA) are elderly (1). As life expectancy rises, the number of patients with the elderly-onset form of the disease (elderly-onset rheumatoid arthritis [EORA]) is expected to increase and physicians will have to manage these patients in the coming years.…”

Section: Introductionmentioning

confidence: 99%

“…The clinical picture of EORA is often character-ized by an acute onset associated with constitutional symptoms (fever, fatigue, weight loss, etc.) (1)(2)(3).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Rituximab in Elderly Patients With Rheumatoid Arthritis Enrolled in a French Society of Rheumatology Registry

Payet

Soubrier

Perrodeau³

et al. 2014

Arthritis Care & Research

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Objective. The aim of this study was to compare the efficacy and safety of rituximab (RTX) as a function of patient age. Methods. We included all rheumatoid arthritis patients in the AutoImmunity and Rituximab registry with a 2-year followup. Results. Of the 1,709 patients, 191 were age >75 years, 417 were ages 65-74 years, 907 were ages 50 -64 years, and 194 were age <50 years. At baseline, the elderly and very elderly patients presented with longer disease duration, a higher incidence of erythrocyte sedimentation rate and C-reactive protein level, a lower incidence of previous tumor necrosis factor ␣ (TNF␣) therapy, and a smaller number of previously used TNF␣ agents. Disease activity, rheumatoid factor (RF), or anti-cyclic citrullinated peptide (anti-CCP) antibodies and corticosteroid therapy were not statistically different among the groups. At 24 months, no significant difference was shown among the groups for RTX discontinuation rates (36.1% if age <50 years, 32.6% if ages 50 -64 years, 34.5% if ages 65-74 years, and 32.5% if age >75 years). The reasons for discontinuation (inefficacy, adverse events) were the same in all 4 groups. Infections were more common in the elderly. Patients ages 65-75 years were more likely to be good responders than nonresponders at 1 year of followup than patients age >75 years (odds ratio 3.81, 95% confidence interval 1.14 -12.79) after adjustment on disease duration, RF/anti-CCP positivity, corticosteroids, anti-TNF use, and baseline Disease Activity Score in 28 joints (DAS28). After the sixth month, the decrease in DAS28 score was less marked in the population age >75 years than in the group age <50 years. Conclusion. The efficacy and safety of RTX is affected by age.

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“…15,16 According to other authors, the inflammation control would reduce cardiovascular mortality in RA. 17 In patients, any factor was significantly involved in this AS. However in the control group, the PWVft is strongly and significantly correlated with age (p=0.023 and r=0.55).…”

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confidence: 87%

Evaluation of the pulse wave velocity in African rheumatoid arthritis subjects

et al. 2016

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Background: Rheumatoid arthritis is a systemic disease with often fatal vascular events. In addition to traditional cardiovascular risk factors, disease-specific elements contribute to this cardiovascular mortality. The aim of this study was to assess arterial stiffness in rheumatoid arthritis and to determine the factors involved.Methods: We have recruited the black African patients followed in rheumatology and had rheumatoid arthritis diagnosis. Only patients between 18 and 60 years and meeting the American College of Rheumatology criteria were included. All controls were healthy. We evaluated the propagation velocity of the pulse wave finger-toe (PWVft) measured by the pOpmètre®.Results: Present study shows that the PWVft was significantly elevated in over half of patients (55.10%). Besides, the mean patients PWVft was significantly higher than that of the control (respectively 9.40±0.51 and 7.22±0.33 p=0.001). In the patients, no factor was significantly involved in the arterial stiffness, but cons in the control group, the PWVft was significantly correlated with age (p=0.023 and r=0.55).Conclusions: Rheumatoid arthritis patients had higher PWVft compared to controls. Due to the importance of its cardiovascular morbidity and mortality, arthritis requires a regular monitoring element as arterial stiffness, which is currently a major vascular parameter monitoring.

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Elderly-onset rheumatoid arthritis

Cited by 56 publications

References 55 publications

Safety and Efficacy of Biological Disease-Modifying Antirheumatic Drugs in Older Rheumatoid Arthritis Patients: Staying the Distance

Safety and Efficacy of Biological Disease-Modifying Antirheumatic Drugs in Older Rheumatoid Arthritis Patients: Staying the Distance

Efficacy and Safety of Rituximab in Elderly Patients With Rheumatoid Arthritis Enrolled in a French Society of Rheumatology Registry

Evaluation of the pulse wave velocity in African rheumatoid arthritis subjects

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