Elderly RA patients get less MTX, fewer biologics and DMARDs

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Elderly RA patients get less MTX, fewer biologics and DMARDs



Feb 9, 2006



Janis

San Diego, CA - Patients with rheumatoid arthritis (RA) diagnosed

after age 60 generally receive less aggressive treatment than

patients with similar disease duration who were diagnosed at younger

ages, according to Dr Zuhre Tutuncu ( University of California, San

Diego) and colleagues [1]. In an analysis published online January

13, 2006 in the ls of the Rheumatic Diseases, Tutuncu reports

that the older patients received lower doses of methotrexate (MTX),

were less likely to be treated with combinations of disease-modifying

antirheumatic drugs (DMARDs), were more likely to be taking

prednisone, and were less often treated with biologics such as TNF

inhibitors.

These differences might reflect other differences between the patient

groups, but Tutuncu writes, " Current management strategies in the

elderly population may be based more on assumptions than evidence. "

Too much prednisone, too few DMARDs?





Current management strategies in the elderly population may be based

more on assumptions than evidence.





The investigators used data from the Consortium of Rheumatology

Researchers of North America (CORRONA) registry to compare disease

activity and treatment in 2101 older RA patients (diagnosed after age

60) and 2101 younger RA patients (diagnosed between ages 40 and 60).

Patients were matched for disease duration. The researchers looked at

the proportion of patients in each group on MTX, multiple DMARDs, and

biologic agents (etanercept, infliximab, adalimumab, or anakinra).

Disease activity and severity differed somewhat between the groups of

patients, with the younger cohort reporting higher tender joint

scores and greater pain despite generally more aggressive treatment.

The data suggest that elderly RA patients are getting more prednisone

and less disease-modifying therapy than younger patients.

Patient characteristics and RA treatment



Variable

Age at RA diagnosis >60 y

Age at RA diagnosis 40-60 y

p

MTX use (%)

63.9

59.6

<0.01

Mean weekly MTX (mg)

11.96

13.3

>1 DMARD (%)

30.9

40.5

<0.0001

Biologics (%)

25

33.1

<0.0001

Prednisone (%)

41

37.64

<0.025

RA duration (y)

5.3

5.3

NS

DAS28

3.8

3.6

NS

Tender joint score

3.7

4.7

0.0001

Patient pain VAS

31.4

34.0

0.001

Physician global assessment

24.9

26.3

0.032



To download table as a slide, click on slide logo below

" The difference in methotrexate dosage and the frequency of biologic

use in the elderly population in this study might reflect factors

such as less clinical activity, lower weight, or increased rate of

comorbidities, " Tutuncu told rheumawire. " The slightly lower doses of

methotrexate and less frequent use of biologics may simply imply good

clinical practice and adjustment of the clinician to patient status. "

However, Tutuncu points out that cross-sectional studies have failed

to identify any important clinical differences between elderly-onset

RA and younger-onset RA patients and that greater efforts should be

made to include elderly patients in RA clinical trials.

http://www.jointandbone.org/viewArticle.do?primaryKey=644363