THE CLINICAL-FEATURES OF ELDERLY-ONSET RHEUMATOID-ARTHRITIS - A COMPARISON WITH YOUNGER-ONSET DISEASE OF SIMILAR DURATION
THE CLINICAL-FEATURES OF ELDERLY-ONSET RHEUMATOID-ARTHRITIS - A COMPARISON WITH YOUNGER-ONSET DISEASE OF SIMILAR DURATION
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DOI：
10.1002/art.1780280905
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发表时间：
1985-01-01
影响因子：
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通讯作者：
COHEN, AS
中科院分区：
文献类型：
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作者：
DEAL, CL;MEENAN, RF;COHEN, AS
老年发病的类风湿性关节炎（EORA）患者可能代表了一个临床亚群，其预后和治疗方法与年轻发病的类风湿性关节炎（YORA）患者不同。为了验证这一假设，我们回顾了212例类风湿关节炎患者的记录，并根据发病年龄在60岁以上或以下进行了分组。EORA患者78例，YORA患者134例，病程为1个月。10年用于比较表现特征和疾病结局。突发性发作在EORA中更为常见，但与老年组的隐匿性表现相比，与临床病程没有显著差异。在平均初始关节评分方面，EORA组和YORA组之间没有差异，尽管YORA组的评分差异更大。最初的临床表现类似风湿性多肌痛（PMR）是EORA患者的4倍。老年患者发病时皮下结节或类风湿因子较少。在期末检查中，尽管治疗过程相似，EORA患者的关节评分较低，健康评估较高。当排除pmr样表现的患者时，这些结果差异仍然存在。多变量分析表明，关节评分和疾病持续时间对EORA的预后有重要影响，而PMR表现和突然发作则没有作用。在对这4个特征进行调整后，发病年龄是影响关节评分结果的重要因素。这些结果证实了EORA患者与YORA患者在发病、临床特征和预后方面存在重要差异。
Patients with elderly-onset rheumatoid arthritis (EORA) may represent a clinical subset of individuals who differ prognostically and therapeutically from patients with younger-onset disease (YORA). In order to test this hypothesis, we reviewed the records of 212 patients with rheumatoid arthritis and grouped them according to age at onset above or below 60 years old. Seventy-eight EORA patients and 134 YORA patients with disease duration of .ltoreq. 10 years were used for a comparison of presenting features and disease outcome. Abrupt onset occurred somewhat more frequently in EORA, but was not associated with a significantly different clinical course than was an insidious presentation in this older group. There were no differences between the EORA and YORA groups in terms of mean initial joint score, although the scores for the YORA group had wider variation. An initial clinical presentation resembling polymyalgia rheumatica (PMR) was 4 times as frequent in EORA. Elderly patients were less likely to have subcutaneous nodules or rheumatoid factor at disease onset. At the final examination, the EORA patients had lower joint scores and higher health assessments despite similar courses of treatment. These outcome differences persisted when patients with PMR-like presentations were excluded. Multivariate analyses indicated that joint scores and disease duration made important contributions to a better outcome of EORA, whereas PMR presentation and abrupt onset did not. After an adjustment was made for these 4 features, age at onset was an important contribution to joint score outcome. These results confirm the existence of important differences in onset, clinical features, and prognosis between patients with EORA and those with YORA.