| Objective:Through clinical analysis of rheumatoid arthritis of different ages of onset,to investigate the clinical characteristics of elderly-onset rheumatoid arthritis (EORA) and the differences of the clinical characteristics between EORA and non-elderly-onset rheumatoid arthritis (NEORA), so that to provide experience and scientific basis for the diagnosis and treatment of EORA.Methods:This research collects the clinical data of 199 cases of hospital patients with rheumatoid arthritis in Rheumatology and Immunology Dept of China-Japan Union Hospital from January, 2010 to February, 2011. Patients are divided into three groups according to age and age at onset of disease. Three groups are EORA (≥60 years, disease onset after 60 years of age), NEORA 1 (20-59 years, disease onset from 20 to 59 years of age), NEORA 2 (≥60 years, disease onset before 60 years of age). All patients are analyzed and compared based on clinical characteristics and laboratory examination.Results:1. Patient characteristics: The mean disease duration of EORA, NEORA 1 and NEORA 2 is 2.5±3.8 years, 3.6±4.2 years and 15.6±10.6 years. The female-to-male ratio is 2.25∶1 in EORA, 6.69∶1 in NEORA 1, 11∶1 in NEORA 2 with a significant statistical difference between EORA and NEORA where P value <0.05. EORA patients more frequently have an abrupt onset of the disease(62% vs. 35% of NEORA 1 cases and 13% of NEORA 2 cases).2. Joint performance: Shoulders are mainly involved in EORA group and NEORA 2 group more than in NEORA 1 group (P<0.05). The starting joints which are shoulders, elbows are more common in EORA than that in NEORA1 and in NEORA 2. There is no significant difference of duration of morning stiffness between EORA and NEORA. There are obvious less articular malformations in EORA group than in NEORA2.There are more articular malformations in NEORA 2 group than in NEORA 1.3. Extra-articular features: Secondary sjogren syndrome is present in 2 (3.8%) of EORA, and in 5 (20.8%) of NEORA2 patients with a significant statistical difference between EORA and NEORA2 where P<0.05. Interstitial pneumonia is present in 11 (21.2%) of EORA, and in 7 (5.7%) of NEORA1 patients with a significant statistical difference between EORA and NEORA1 where P<0.01. There are more cases with secondary sjogren syndrome and interstitial pneumonia in NEORA 2 than in NEORA 1.4. Disease activity characteristics: Swollen joint count mean is 12.5±8.5 in EORA group, 9.8±8.0 in NEORA1 with a significant statistical difference between EORA and NEORA1 where P value=0.046. The mean of tender joint count is 13.3±9.4 in EORA group, 10.0±8.0 in NEORA 1 group with a significant statistical difference between EORA and NEORA1 where P value=0.028. Disease activity is increased in EORA compared to NEORA 1, with higher tender and swollen joint counts and disease activity score in 28 joints. There is no significant statistical difference in the value of erythrocyte sedimentation rate and C-reactive protein between EORA and NEORA1.5. The laboratory features: The proportion of patients with rheumatoid factor in EORA is lower than that in NEORA1 and NEORA2(P<0.05), rheumatoid factor is positive in 56% cases in EORA compared to 74% in NEORA1 and 79% in NEORA2. Elevations of rheumatoid factor are noted in NEORA1 and NEORA2 as compared to EORA. The value of albumin in EORA is lower than that in NEORA1. The proportion of patients with anti-CCP antibodies in EORA has no significant difference with NEORA1 and NEORA2.The value of serum Immunoglobulin M in EORA is lower than that in NEORA1.6. In X-ray staging, EORA patients have less serious destruction of joint and bone than NEORA2. The radiological change of EORA group is similar to that of NEORA1, there is not statistically significant.7. Correlation:DAS28(ESR)and DAS28(CRP)are related to duration of morning stiffness in three groups. DAS28(CRP) is related to platelets both in EORA and in NEORA1(P<0.05,r=0.307,r=0.434). Swollen joint count is related to duration of morning stiffness among EORA, NEORA1 and NEORA2(P<0.05,r=0.320,r=0.137,r=0.506). Swollen joint count is related to tender joint count among EORA, NEORA1 and NEORA2 (P<0.05,r=0.495,r=0.599,r=0.895). Tender joint count is related to duration of morning stiffness in three groups.Conclusion:1. The incidence of men increases in EORA. AS the growth of age, the incidence of men in RA increases, the female-to-male ratio is less marked. 2. EORA patients more frequently have an abrupt onset of the disease. The starting joints which are shoulders, elbows are more common in EORA. The proportion of patients with rheumatoid factor in EORA is lower. The onset way and involved joints of EORA group are different from NEORA, we should prevent misdiagnosis.3. Disease activity is increased in EORA compared to NEORA 1, with higher tender and swollen joint counts and disease activity score in 28 joints. Therefore EORA patients should be actively treated so as to alleviate symptoms and control the progress of the disease, reduce joint damage, prevent joint deformities and joint dysfunction.4. Interstitial pneumonia,age and disease duration are concerned among RA patients. The older the RA patients are and the longer disease duration lasts,the more prone to suffer from interstitial pneumonia. Secondary sjogren syndrome and disease duration are related among RA patients.5. The X-ray staging of RA patients has no correlation with age at onset. The X-ray staging of RA patients has correlation with disease duration. The longer time patients suffer from RA for, the more serious stages they have.
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