The Clinical Analysis Of Elderly-onset Rheumatoid Arthritis Of 63 Cases

Objective : To compare the clinical data of elderly onset rheumatoid arthritis(EORA)and younger onset rheumatoid arthritis(YORA),explore the clinical features of EORA and the differences of the clinicalfeaturesbetween EORA and YORA,improve the diagnosis and treatment of EORA.Methods:The clinical data of 124 patients with rheumatoid arthritis in Rheumatology and Immunology departmentof yijishan Hospitalfor the first timefrom September 2016 to March 2018 were reviewed retrospective.The cut-off between EORA and YORAwasoperationallyset at65 years of age at disease onset.The two groups of RA patients are compared and analyzed based on general data,laboratory examination and treatment schemes.Results:1.general data: sex ratio of EORA group and YORA group(male / female)were 1:1.6 and 1:5.7,with higher male / female ratio in in group EORA(P < 0.01),the median course of disease in the two groups was 12(4,18)months and 12(3,36)months,no significant differences were found between the two groups.2.involved joints: wrist joint,proximal interphalangeal joint and knee joint involvement were more common in two groups.EORA had more frequent involvementof shoulder joint,but YORA had more frequent involvementof metacarpophalangeal joint(P<0.05).The elbow and ankle joint involvement ratio was higher in EORA group than in YORA group,and there was no significant difference.the incidence rate of large joint in EORA group was significantly higher than that in YORA group(P < 0.05).3.Disease activity and laboratory examination comparison: the average level of swelling joint count and tenderness joint count in EORA group was higher than that in YORA group,and the titer of anti CCP antibody was lower than that in YORA group.there were no significant differences in two groups.But the ESR,CRP,RF titer,DAS28-ESR levels were higher in EORA group than YORA group(P<0.05);no significant differencewere found between EORA and YORA in RF,anti CCP antibody positive rate and joint X ray staging.4.Comorbiditycomparison:the incidence of complications in EORA patients was significantly higher than that in group YORA,especially with hypertension and cardiovascular disease.The two groups were all associated with interstitial pulmonary diseases,the difference was not significant.EORA is more likely to be associated with osteoarthritis,osteoporosis,anemia,diabetes,and abnormal thyroid function and other diseases.5.Comparison of treatment regimens: DMARDs single regimen and DMARDs combined with phytopathic regimen were more commonly(P<0.01),YORA group had more DMARDs combination programs(P<0.01),The use of MTX in EORA group was less than YORA(P<0.01).The use rate of low dose MTX in group EORA was higher than that in group YORA.The use of biological preparation in EORA group was less than that in YORA group,but the difference was not significant.Conclusion:The clinical manifestation of EORA patients is atypical and it is easy to be complicated with multi-system diseases.The possibility of EORA may be considered in clinical diagnosis and treatment for Shoulder onse in elderly malewith negative anti-CCP antibodies.