Recent onset arthritis in the elderly: A 5 year longitudinal observationalstudy

Objective. To study the spectrum of diagnoses. course, and outcome of recen t onset arthritis after the age of 60, presenting as rheumatoid arthritis ( RA)-like disease. Methods. A 5 year longitudinal observational study enrolled 92 consecutive patients (median age 73 yrs, 54/38 women/men, median duration of arthritis 12 weeks at inclusion). Results. Forty-eight percent were classified as having RA according to the 1987 American Rheumatism Association criteria, 52% as non-RA (41.4% undiffe rentiated seronegative polyarthritis, 10.8% oligoarthritis with polymyalgic symptoms). Symmetrical involvement of small and medium size joints was mor e predominant in the RA (91 and 84%, respectively) than the non-RA patients (58 and 52%). The patients with RA compared to non-RA had more active and serious disease at onset, reflected by significant differences in number of swollen joints (median values 18 and 9, respectively), duration of morning stiffness (75 and 10 min), physician's global assessment of disease activi ty (45 and 28 mm on visual analog scale), and Health Assessment Questionnai re (HAQ) score for functional disability (1.8 and 1.0). Improvement during the course was observed in disease process variables as well as in HAQ disa bility score for both RA and non-RA patients. Risk factors for a poor 5 yea r functional outcome were female sex (OR 4.24). diagnosis of RA (OR 3.28), and baseline HAQ score greater than or equal to 1.4 (OR 3.52). The median c hange in radiological progression (Larsen-Dale index) was zero. Twenty pati ents died during followup, the majority from cardiovascular diseases, infec tions, and malignancies. Mortality compared to the age and sex matched gene ral population was increased for rheumatoid factor (RF) positive patients ( standardized mortality ratio 272). Mortality risk factors within the patien t cohort were male sex (OR 4.35), age (OR 1.17), and having RF+ RA (OR 11.9 3). Conclusion. Arthritis in the elderly is a heterogeneous group of arthritide s with an overall favorable functional prognosis, The subgroup of women wit h elderly onset RA with functional disability at onset is at risk for a les s favorable functional outcome. Mortality was increased for the patients wi th RF+ elderly onset RA only.