2005: Comparison of Treatment and Disease Activity in the Early Stage of Onset in Patients with Elderly-onset vs Younger-onset Rheumatoid Arthritis Using Data of National Database of Rheumatic Diseases in Japan (NinJa)
Toshihiro Matsui1 and Shigeto Tohma2, 1NHO Sagamihara National Hospital, Kanagawa, Japan, 2National Hospital Organization Tokyo National Hospital, Dallas, TX
Background/Purpose: To clarify the current status and issues concerning treatment in the early stage of onset in patients with elderly-onset rheumatoid arthritis (RA) in Japan.
Methods: From the 16,086 patients with RA registered in the nationwide RA database "NinJa" (National Database of Rheumatic Diseases in Japan) in 2019, cases with onset of less than 2 years were extracted. Furthermore, these patients were divided into the following 3 groups according to the age of onset; G1 group (< 65 years old, n=464), G2 group (65-74 years old, n=245), and G3 group (≧75 years old, n=255), respectively. Among 3 groups, the differences in disease activity and treatment content were compared. Additionally, these were also compared by the differences in the attending doctor (internist vs orthopedist).
Results: The median value [IQR] of SDAI (5.2 [2.1-11.0] in G1, 5.0 [1.7-10.3] in G2, and 5.2 [1.9-11.3] in G3) and the remission rate by SDAI (38.4%, 38.8%, and 37.6%) were not significantly different among 3 groups. However, the usage rate of MTX (70.0%, 60.0%, and 38.8%) and the mean dosage (mg/w) of MTX (9.1, 8.5, and 7.6) decreased and that of csDMARDs other than MTX (15.7%, 21.2%, and 41.2%) increased as the group changed from G1 to G3. The proportion of patients using multiple DMARDs (including b/tsDMARDs) was not significantly different among 3 groups (30.2%, 26.1%, and 28.7%). The usage rate of b/tsDMARDs (12.7%, 10.6%, and 14.1%) was not different, but that of bDMARDs (9.3%、6.1%、11.4%) was significantly higher in G3 compared to G2. Especially, the selection rate of nonTNFi/(b/tsDMARDs) was high in G3 (28.8%, 34.6%, and 47.2%). The usage rate of steroids (23.5%, 33.1%, and 43.5%) increased in the G1→G3 group, but NSAIDs decreased (41.2%, 32.7%, and 29.8%), inversely.
There were no differences in the remission rate between patients treated by orthopedist (n=108) (39.3%, 40.9%, and 41.7%) and those treated by internist (n=808) (39.7%, 41.3%, and 38.3%). However, the usage rates of MTX were higher (78.7% vs 70.3%, 77.3% vs 60.5%, and 48.0% vs 39.3%) and those of steroid were lower (24.6% vs 23.8%, 13.6% vs 34.0%, and 32.0% vs 39.7%) in patients treated by orthopedist. The usage rate of b/tsDMARDs in G3 was lower in patients treated by orthopedist than those by internist (4.0% vs 15.9%).
Conclusion: In the early stage of onset, elderly-onset RA patients achieved comparable disease activity control and remission rate to younger-onset RA patients. However, there was a large difference in the treatment content, and the usage rate of steroids was particularly high in elderly-onset RA patients. The pros and cons of achieving steroid-dependent remission in elderly-onset RA patients need to be investigated. In Japan, orthopedists also treat RA patients with drugs, but compared to internists, they treated less frequently difficult-to-treat cases in which MTX could not be used and steroid dependence was high.
Disclosures: T. Matsui, AbbVie/Abbott, Pfizer, Asahi Kasei Pharma, Astellas Pharm Inc, Chugai Pharmaceutical, Eisai, Mitsubishi-Tanabe Pharma, Taisho Pharmaceutical, Daiichi Sankyo, Eli Lilly, Ono Pharmaceutical, Takeda Pharmaceutical, UCB; S. Tohma, Pfizer, Mitsubishi-Tanabe Pharma, Daiichi Sankyo, Chugai Pharmaceutical, AbbVie/Abbott, Ono Pharmaceutical, Takeda Pharmaceutical, Astellas Pharm, Ayumi Pharmaceutical, QIAGEN K.K, Asahi Kasei Pharma.
