International overview on juvenile-, adult- and elderly-onset rheumatoid arthritis: The age at disease onset as a fundamental determinant of clinical presentation

Nevin Hammam¹, Tahsin El-Hadidi², Khaled El-Hadidi³, Ahmed Elsaman⁴, Samah A El-Bakry⁵, Maha Nassr⁶, Hanan M El-Saadany⁷, Doaa Mosad⁸, Samah I Nasef⁹, Zahraa I Selim¹, Nermeen Samy⁵, Abdelhfeez Moshrif¹⁰, Hanan Taha¹¹, Rasha M Fawzy¹², Suzan S Al-Adle³, Amira M Ibrahim¹³, Nora Y Elsaid³, Samar Tharwat¹⁴, Nada M Gamal¹, Maha E Ibrahim⁹, Soha Senara⁶, Rawhya El Shereef¹⁵, Marwa A Amer¹⁶, Faten Ismail¹⁵, Mervat I Abd Elazeem¹⁷, Nouran M Abaza¹⁸, Eman F Mohamed¹⁹, Dina F El-Essawi²⁰, Saad M Elzokm²¹, Samar M Fawzy³, Nahla N Eesa³, Enas A Abdelaleem¹⁷, Ahmed M Abdalla²², Hanan M Fathi⁶, Hatem H El-Eishi³, Safaa Sayed³, Reem Hamdy A Mohammed³, Tamer A Gheita³

Affiliations

¹ Rheumatology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
² Rheumatology Department, Military Academy, Agouza Rheumatology Center, Giza, Egypt.
³ Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
⁴ Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt.
⁵ Internal Medicine Department, Faculty of Medicine, Rheumatology Unit, Ain-Shams University, Cairo, Egypt.
⁶ Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt.
⁷ Rheumatology Department, Faculty of Medicine, Tanta University, Gharbia, Egypt.
⁸ Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Egypt.
⁹ Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt.
¹⁰ Rheumatology Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
¹¹ Internal Medicine Department, Faculty of Medicine, Rheumatology Unit, Beni-Suef University, Beni-Suef, Egypt.
¹² Rheumatology Department, Faculty of Medicine, Benha University, Kalyoubia, Egypt.
¹³ Rheumatology Department, Faculty of Medicine, Kafr El-Skeikh University, Kafr Al Sheikh, Egypt.
¹⁴ Internal Medicine Department, Faculty of Medicine, Rheumatology and Immunology Unit, Mansoura University, Dakahlia, Egypt. samartharwat2000@mans.edu.eg.
¹⁵ Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt.
¹⁶ Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
¹⁷ Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.
¹⁸ Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
¹⁹ Internal Medicine Department, Faculty of Medicine (Girls), Rheumatology Unit, Al-Azhar University, Cairo, Egypt.
²⁰ Internal Medicine Department, Rheumatology Unit (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt.
²¹ Rheumatology Department, Faculty of Medicine, Al-Azhar University, Damiette, Egypt.
²² Rheumatology and Rehabilitation Department, Faculty of medicine, Damietta University, Damietta, Egypt.

PMID: 39913010
PMCID: PMC11865098
DOI: 10.1007/s10067-025-07356-5

International overview on juvenile-, adult- and elderly-onset rheumatoid arthritis: The age at disease onset as a fundamental determinant of clinical presentation

Nevin Hammam et al. Clin Rheumatol. 2025 Mar.

. 2025 Mar;44(3):979-988.

doi: 10.1007/s10067-025-07356-5. Epub 2025 Feb 6.

Authors

Affiliations

¹ Rheumatology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
² Rheumatology Department, Military Academy, Agouza Rheumatology Center, Giza, Egypt.
³ Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
⁴ Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt.
⁵ Internal Medicine Department, Faculty of Medicine, Rheumatology Unit, Ain-Shams University, Cairo, Egypt.
⁶ Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt.
⁷ Rheumatology Department, Faculty of Medicine, Tanta University, Gharbia, Egypt.
⁸ Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Egypt.
⁹ Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt.
¹⁰ Rheumatology Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
¹¹ Internal Medicine Department, Faculty of Medicine, Rheumatology Unit, Beni-Suef University, Beni-Suef, Egypt.
¹² Rheumatology Department, Faculty of Medicine, Benha University, Kalyoubia, Egypt.
¹³ Rheumatology Department, Faculty of Medicine, Kafr El-Skeikh University, Kafr Al Sheikh, Egypt.
¹⁴ Internal Medicine Department, Faculty of Medicine, Rheumatology and Immunology Unit, Mansoura University, Dakahlia, Egypt. samartharwat2000@mans.edu.eg.
¹⁵ Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt.
¹⁶ Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
¹⁷ Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.
¹⁸ Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
¹⁹ Internal Medicine Department, Faculty of Medicine (Girls), Rheumatology Unit, Al-Azhar University, Cairo, Egypt.
²⁰ Internal Medicine Department, Rheumatology Unit (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt.
²¹ Rheumatology Department, Faculty of Medicine, Al-Azhar University, Damiette, Egypt.
²² Rheumatology and Rehabilitation Department, Faculty of medicine, Damietta University, Damietta, Egypt.

PMID: 39913010
PMCID: PMC11865098
DOI: 10.1007/s10067-025-07356-5

Abstract

Background: Elderly-onset rheumatoid arthritis (EORA) may have peculiar findings compared to juvenile-onset RA (JORA). The aim of the work was to present and compare the clinical characteristics of RA patients with JORA and elderly-onset EORA to a group of cases with adult-onset (AORA) and to contrast the findings worldwide.

Methods: The study included 1100 adult RA patients: 209 JORA and 329 EORA, compared with 562 AORA extracted from a big data national study on 10,364 RA patients. Clinical characteristics, laboratory investigations, medications received, and co-morbidities were recorded. The disease activity index (DAS28) and health assessment questionnaire (HAQ) were estimated.

Results: The JORA cases represented 19% and EORA 29.9% of the included cohort. The mean age at onset for JORA, EORA, and AORA were 15.1 ± 2.1, 64 ± 4.2, and 36.4 ± 10 years (p < 0.0001), and the female-male ratio was 6.2:1, 2.7:1, and 7.3:1 (p < 0.0001), respectively. In EORA, body mass index (28.8 ± 5.8) and frequencies of smokers (11.6%), diabetes (12.2%), hypertension (19.8%), and osteoporosis (5.2%) were significantly higher than in JORA (26.02 ± 5; 5.3%, 2.9%, 3.8%, and 1%) and AORA (27.6 ± 5.6; 3%, 8.4%, 14.9%, and 2.3%, p = 0.016) (p < 0.0001, p = 0.001, p < 0.0001, and p = 0.009, respectively). In JORA, oral ulcers were significantly more frequent (p = 0.04); in EORA, cardiovascular manifestations (p < 0.0001) and hypothyroidism (p = 0.039) were more frequent; and DAS28 (p = 0.01) and HAQ (p = 0.038) were higher. Fibromyalgia and methotrexate administration were significantly more frequent in AORA (p < 0.0001 and p = 0.04, respectively). Rheumatoid factor, anti-cyclic citrullinated peptide, and double seropositivity were significantly more frequent in EORA (p < 0.0001, p = 0.008, and p = 0.002, respectively).

Conclusion: Comorbidities, cardiovascular manifestations, hypothyroidism, higher disease activity, and functional disability are more common in EORA patients. Key Points • Juvenile-onset and elderly-onset RA patients have notable differences compared to the adult-onset cases. • Co-morbidities and certain manifestations, including cardiovascular disease and hypothyroidism, as well as higher disease activity and functional disability, are more common in elderly-onset patients. • Fibromyalgia remains more frequent in adult-onset cases.

Keywords: Adult-onset; Comorbidities; DAS28; Elderly-onset; Juvenile-onset; Rheumatoid arthritis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was in accordance with the institutional ethical committee and was in accordance with the 1964 Helsinki Declaration. The patients provided informed consent to participate. Consent for publication: Not applicable. Disclosure: None.

References

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International overview on juvenile-, adult- and elderly-onset rheumatoid arthritis: The age at disease onset as a fundamental determinant of clinical presentation

Affiliations

International overview on juvenile-, adult- and elderly-onset rheumatoid arthritis: The age at disease onset as a fundamental determinant of clinical presentation

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical