Major Finding: For every 10-year increase in age, the chance of a patient with RA receiving more intensive treatment reduces by approximately 22%.
Data Source: Repeat cross-sectional study of 290 patients with RA.
Disclosures: Dr. Ma and Dr. Deighton had no conflicts of interest to declare.
BIRMINGHAM, ENGLAND — Elderly patients with rheumatoid arthritis are treated less intensively than their younger counterparts, despite experiencing similar levels of disease activity.
Data from a cross-sectional study that was conducted at two centers in the United Kingdom show that for every 10-year increase in age, the chance of an RA patient's receiving more intensive treatment is reduced by approximately 22%.
“Unfortunately, the elderly population is not well represented in clinical studies,” said Dr. Margaret H.Y. Ma, a clinical research fellow at King's College Hospital in London.
“In routine clinical practice, we see a much larger proportion of elderly patients, and it is unclear currently how well we treat this population,” Dr. Ma said.
The incidence and prevalence of RA increases with age, and it is in the elderly (aged 65 years and older) that disease-related disabilities usually have the greatest impact. Therefore, the aim of the study was to examine the effects of age and other variables on the treatment of RA.
Dr. Ma reported that the study, performed in 2009–2010 and involving 290 participants, was a repeat of a similar investigation that was performed in 2007–2008 and involved 236 people. The original and repeat cohorts of patients were similar in terms of age (58 and 59 years, respectively), sex (79% vs. 81% female), and ethnicity (70% vs. 72% white; 20% vs. 19% Afro-Caribbean). Treatment plans also were similar between the cohorts (80% vs. 81% taking disease-modifying antirheumatic drugs [DMARDs]; 11% vs. 11% taking steroids; 15% vs. 17% taking biologics).
Patients in the repeat study, however, were more likely to have longer disease duration (10 years vs. 8.3 years), as well as a lower 28-joint disease activity score, or DAS28 (4.1 vs. 3.78), than did those who took part in the original study.
Both studies showed that there was a significant effect of age and disease activity on the chances that patients would be given more intensive therapy. While older patients were less likely to receive treatment increases (odds ratio, 0.83 in the original study and 0.82 in the repeat study), higher disease activity was associated with more intensive therapy (OR, 2.15 and 2.39, respectively).
Adjustment for possible confounding factors revealed that age and disease activity were the only determinants of treatment changes.
In the 2009–2010 cohort, the percentage of patients aged 65 years and older on DMARDs, steroids, and biologics was 77%, 11%, and 11%, whereas the percentage of those younger than 65 years who took these drugs was 83%, 19%, and 19%.
“What stuck us the most was the comparison of disease activity,” Dr. Ma said. When they compared patients aged 65 years or older vs. those younger than 65 years, they found that there were no differences in disease activity, with both age groups exhibiting a similar spectrum of disease activity in both the original and repeat studies. However, for the same DAS28, elderly patients were less likely than younger patients to receive an increase in therapy if they had more moderate disease, Dr. Ma reported.
“It is interesting because in patients that have got very active disease, then it seems that, irrespective of their age, we are more likely to try to treat their disease more aggressively,” Dr. Chris Deighton, consultant rheumatologist at the Derbyshire Royal Infirmary, Derby, England, commented.
“If they have got moderate disease, then there is probably more of a negotiation that takes place” between the patient and physician, Dr. Deighton added.