Trends of disease activity in Japanese patients over 75 years with rheumatoid arthritis from 2014 to 2021- the ANSWER cohort study

Hirotaka Yamada; Sadao Jinno; Toshihisa Maeda; Shinya Hayashi; Wataru Yamamoto; Akira Onishi; Hideo Onizawa; Tohru Takeuchi; Yuri Hiramatsu; Yasutaka Okita; Kosuke Ebina; Yonsu Son; Naofumi Yoshida; Ryu Watanabe; Ryota Hara; Mai Yamashita; Yoko Nose; Yuzuru Yamamoto; Takaichi Okano; Keisuke Nishimura; Yo Ueda; Sho Sendo; Motomu Hashimoto; Ryosuke Kuroda; Jun Saegusa

doi:10.1093/rheumatology/kead539

Trends of disease activity in Japanese patients over 75 years with rheumatoid arthritis from 2014 to 2021- the ANSWER cohort study

Rheumatology (Oxford). 2023 Oct 4:kead539. doi: 10.1093/rheumatology/kead539. Online ahead of print.

Authors

Hirotaka Yamada¹, Sadao Jinno^{1

2}, Toshihisa Maeda³, Shinya Hayashi³, Wataru Yamamoto⁴, Akira Onishi⁵, Hideo Onizawa⁵, Tohru Takeuchi⁶, Yuri Hiramatsu⁶, Yasutaka Okita⁷, Kosuke Ebina⁸, Yonsu Son⁹, Naofumi Yoshida^{9

10}, Ryu Watanabe¹⁰, Ryota Hara¹¹, Mai Yamashita¹, Yoko Nose¹, Yuzuru Yamamoto¹, Takaichi Okano¹, Keisuke Nishimura¹, Yo Ueda¹, Sho Sendo¹, Motomu Hashimoto¹⁰, Ryosuke Kuroda³, Jun Saegusa¹

Affiliations

¹ Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan.
² Department of Medicine, University of Hawaii, Honolulu, Hawaii, USA.
³ Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
⁴ Department of Health Information Management, Kurashiki Sweet Hospital, Okayama, Japan.
⁵ Department of Advanced Medicine for Rheumatic diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁶ Department of Internal Medicine (IV), Osaka Medical and Pharmaceutical University, Osaka, Japan.
⁷ Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan.
⁸ Department of Musculoskeletal Regenerative Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.
⁹ First Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
¹⁰ Department of Clinical Immunology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
¹¹ Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan.

PMID: 37792494
DOI: 10.1093/rheumatology/kead539

Abstract

Objectives: To investigate if disease activity among elderly RA patients over 75 years has changed over time in the real-world clinical setting.

Methods: Data from an observational multicentre registry of RA patients in Japan were analyzed. The primary outcome was to evaluate the changes in the proportion of very elderly RA patients (over 75 years) who achieved remission and low disease activity, from 2014 to 2021. The secondary outcome was to identify factors associated with remission and low disease activity by comparing demographic and clinical characteristics among the patients who had a study visit within the study period, using multivariate logistic regression.

Results: A total of 32 161 patient visits were identified from 2014 to 2021. The proportion of patients over 75 years increased from 16.5% to 26.9%, with biologics and targeted-synthetic disease modifying anti-rheumatic drugs (b/tsDMARDs) usage increasing and glucocorticoids usage decreasing, while conventional-synthetic DMARDs usage remained relatively stable. The proportion of RA patients over 75 years achieving remission and low disease activity significantly increased from 62.2% to 78.2% (p for trend < 0.001). A negative factor associated with achieving remission and low disease activity was glucocorticoid usage, seropositivity, and history of previous b/tsDMARDs use while MTX usage was associated positively, independent of other predictors.

Conclusions: In our cohort, disease activity among very elderly RA patients has improved over time. The study suggests the importance of using a treat-to-target approach in very elderly RA patients to improve clinical outcomes.

Keywords: ANSWER cohort; biologics and targeted-synthetic disease modifying anti-rheumatic drugs; conventional-synthetic disease modifying anti-rheumatic drugs; elderly; rheumatoid arthritis.