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Observational Study
. 2020 Aug;50(4):735-743.
doi: 10.1016/j.semarthrit.2020.03.018. Epub 2020 May 15.

Treatment-resistant synovitis and radiographic progression are increased in elderly-onset rheumatoid arthritis patients: findings from a prospective observational longitudinal early arthritis cohort study

Vasco C Romão  1 , Frances Humby  2 , Stephen Kelly  3 , Maria Di Cicco  2 , Arti Mahto  2 , Ilias Lazarou  2 , Rebecca Hands  2 , Vidalba Rocher-Ros  2 , Désirée van der Heijde  4 , João Eurico Fonseca  5 , Costantino Pitzalis  6
Affiliations
Observational Study

Treatment-resistant synovitis and radiographic progression are increased in elderly-onset rheumatoid arthritis patients: findings from a prospective observational longitudinal early arthritis cohort study

Vasco C Romão et al. Semin Arthritis Rheum. 2020 Aug.

Abstract

Background: Clinical outcomes in elderly-onset rheumatoid arthritis (EORA), starting after the age of 60, are conflicting. Thus, we aimed to investigate in a unique biopsy-driven, treatment-naïve early arthritis cohort, the relationship between synovial pathobiology of elderly- (EORA) and younger-onset rheumatoid arthritis (YORA) patients through clinical, imaging and treatment response outcome-measures.

Methods: Patients (n = 140) with early RA (<12months) starting before (YORA, n = 99) or after (EORA, n = 41) age 60 had an ultrasound-guided synovial biopsy prior to conventional immunosuppressive therapy and after 6 months. Clinical, ultrasound and radiographic data were collected prospectively and compared between groups and against immunohistological features. Using multivariate logistic regression, we determined predictors of clinical response (disease activity score-28-erythrocyte sedimentation rate [DAS28-ESR]<3.2) at 6 months and radiographic progression (≥1-unit-increase in Sharp van der Heijde [SvdH] score) at 12 months.

Results: EORA patients were more frequently male and presented most commonly with an abrupt, polymyalgia rheumatica-like onset and extra-articular features. Both before and after treatment, DAS28-ESR was similar but ultrasound synovial-thickening (p<0.05) and power-Doppler (p<0.01) synovitis and SvdH (p<0.001) scores were higher in EORA patients. EORA was independently associated with poor treatment response at 6 months (OR=0.28, p = 0.047) and radiographic progression at 12 months (OR=4.08, p = 0.029). Synovial pathotype, synovitis scores and cellular infiltration were similar before treatment, but a pauci-immune-fibroid pathotype tended to be more common in YORA at 6 months (p = 0.093). Moreover, YORA patients had a marked improvement of all synovitis parameters (p<0.001), whereas EORA presented only mild decreases in synovitis (p<0.05), sublining macrophage (p<0.05) and T cell scores (p<0.05), with no significant changes in lining macrophages, B cells or plasma cells.

Conclusion: Early EORA presents differently and has a worse overall prognosis than YORA, with poorer clinical, histological, ultrasonographic and radiographic outcomes.

Keywords: Elderly-onset; Radiographic progression; Rheumatoid arthritis; Synovial pathobiology; Synovitis.

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Conflict of interest statement

Declaration of Competing Interest VCR reports personal fees and non-financial support from Pfizer and Janssen; non-financial support from Merck Sharp and Dohme, Lilly and Roche, outside the submitted work. SK reports personal fees from UCB Pharma, Janssen and Pfizer, outside the submitted work. VRR reports personal fees from AstraZeneca, outside the submitted work. DvdH reports personal fees from AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Daiichi, Eli-Lilly, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda and UCB, outside the submitted work; and is Director of Imaging Rheumatology bv. JEF reports grants and personal fees from AbbVie, Merck Sharp and Dohme, Pfizer, Roche, UCB Pharma, Janssen, Novartis and Sanofi, outside the submitted work. CP reports grants and personal fees from Abbott / AbbVie, Astellas, AstraZeneca / MedImmune, Bristol-Myers Squibb, Janssen / Johnson & Johnson, Merck Sharp and Dohme, Pfizer, Roche / Genentech / Chugai and UCB Pharma, outside the submitted work. All other authors declare no competing interests.

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