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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.
EORA markedly differs from YORA in several key aspects (Table 1).
Characteristics | EORA | YORA |
---|---|---|
Age of onset | after 65 years | 30–50 |
Prevalence | 2% | 0.5–1% |
Female/male ratio | 1/1 or more men | 3/1 |
Onset | acute and infectious-like | gradual |
Number of joints involved | may be oligoarticular | polyarticular |
Sites involved | large/proximal joint | small joints of the hands and feet |
Fatigue, weight loss | more prominent | less prominent |
Genetic predisposition | HLA-DRB1∗ 01 | HLA-DRB1*04 |
Rheumatoid factor | lower incidence | higher incidence |
Titer for ACPA | higher | lower than EORA |
Subcutaneous nodules | less frequent | more frequent |
Pauci-immune fibroid synovial pathotype | less frequent | more frequent |
Bone erosions | more frequent | frequent |
Elevated ESR/CRP | more frequent | frequent |
Higher WBC, ANC | more frequent | frequent |
Lower PLR, NLR | more frequent | frequent |
Higher IL6, lower TNFα | more frequent | less frequent |
Higher DAS28, CDAI, SDAI | more frequent | frequent |
Higher ultrasound features: ST, PDS, SHC | more frequent | frequent |
Clinical form | classical RA PMR-like form RS3PE s/m like form |
classical RA |
Comorbidity | more frequent | less frequent |
Prognosis | worse | good or worse |
Characteristics | EORA | PMR | RS3PE |
---|---|---|---|
Proximal joints | + | +++ | − |
Peripheral joints | +++ | + | +++ |
Tenosynovitis | ++ | +/− | +++ |
Edema | + | + | +++ |
RF+ | +/− | − | − |
High ESR | + | +++ | + |