Patients with later-onset rheumatoid arthritis (RA) may be receiving less effective treatment than their younger counterparts, a Swedish researcher said here.

For instance, patients older than 58 at the time of diagnosis were less likely to receive disease-modifying anti-rheumatic drugs within 3 months, according to Lena Innala, MD, of University Hospital of Umea in Sweden, and colleagues.

But the older patients were more likely to have received corticosteroids, she reported in a poster session at the annual meeting of the American College of Rheumatology.

"This is not advisable, especially giving high-dose steroids to older patients because of the possibility of comorbidities. It would be better to use methotrexate early," Innala told MedPage Today.

Compared with patients who don't have RA, mortality is higher during any given time period in those who do have the condition, with contributing factors being disease severity and comorbidities associated with both disease and treatments.

Whether age at onset also contributes has been unclear, so she and her colleagues conducted an analysis of all patients with rheumatoid arthritis in Northern Sweden.

The study included 950 patients enrolled in an arthritis registery since 1995, 665 of whom had disease duration of more than 5 years.

The participants were followed prospectively, with regular assessments of disease activity scores, tender and swollen joint counts, and pain and disability scores.

At baseline and again at 5 years, their comorbidities were recorded, as were manifestations of disease severity and all treatment modalities employed.

X-rays of the hand and feet were obtained at baseline and after 2 years.

Because the median age was 58, that was used as the cutoff age for early-onset versus late-onset disease.

Notable differences were seen between the two groups, according to Innala.

At the time of diagnosis older patients had higher erythrocyte sedimentation rates, worse disability scores on the Health Assessment Questionnaire, and higher accumulated disease activity scores at 1 year and 2 years.

"Patients whose disease develops earlier had more risk factors for poor prognosis, but disease activity was greater in those whose disease was diagnosed later," she observed.

Despite this high disease activity, significantly fewer of the older patients received methotrexate or biologics.

The findings of this study suggest the existence of treatment inequalities, Innala said.

"It may be that we are hesitant to treat older patients aggressively out of concern that they could develop malignancies and infections," she said.

But relying on steroids instead of disease-modifying drugs in these patients can increase their likelihood of other serious adverse outcomes such as cardiovascular disease and osteoporosis, she said.

"There are many things to take into consideration in treating older patients with rheumatoid arthritis," she cautioned.

Source: Treatment of RA in Older Patients Questioned