Observational cross-sectional study revealing less aggressive treatment in Japanese elderly than nonelderly patients with rheumatoid arthritis

J Clin Rheumatol. 2010 Dec;16(8):370-4. doi: 10.1097/RHU.0b013e3181fe8b37.


Background: Elderly patients with rheumatoid arthritis (RA) have more aging-related complications than nonelderly patients with RA.

Objectives: The objective of the study was to investigate the treatment status of elderly patients with RA.

Methods: Between January and March 2008, 969 patients with RA were enrolled in this observational cross-sectional study. Prescription of disease-modifying antirheumatic drugs (DMARDs) and corticosteroids and laboratory data related to RA, including matrix metalloproteinase 3, rheumatoid factor, and anti-cyclic citrullinated peptide antibody levels, were compared between the elderly and the nonelderly patients.

Results: Fewer DMARDs were prescribed to the elderly patients (1.40 [SD, 0.57] vs. 1.51 [SD, 0.61]; P = 0.029). Furthermore, a lower percentage of patients received methotrexate (MTX) (47.2% vs. 56.9%; P = 0.0001), a lower average dosage of MTX was administered (5.46 [SD, 1.66] mg/wk vs. 5.96 [SD, 1.77] mg/wk; P = 0.0001), and fewer biologic DMARDs were used (1.46% vs. 5.59% for infliximab, P = 0.0008; 0.58% vs. 3.19% for etanercept, P = 0.0038) in the elderly group. The laboratory data suggested that the disease status was uncontrolled to a greater extent, and complications were more common in the elderly group.

Conclusion: Elderly patients with RA receive less aggressive treatment than nonelderly patients with RA, despite laboratory evidence for poorly controlled disease status among the elderly. The use of a less aggressive regimen could be attributed to the higher prevalence of complications and problems. Therefore, the elderly with RA should be considered a different patient population from the viewpoint of treatment and be administered specialized medical care.

Publication types

  • Comparative Study

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Age Factors
  • Aged
  • Antibodies, Anti-Idiotypic / blood
  • Antibodies, Monoclonal / therapeutic use
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / blood
  • Arthritis, Rheumatoid / drug therapy*
  • Cross-Sectional Studies
  • Dose-Response Relationship, Drug
  • Etanercept
  • Female
  • Humans
  • Immunoglobulin G / therapeutic use
  • Infliximab
  • Male
  • Matrix Metalloproteinase 3 / blood
  • Methotrexate / therapeutic use
  • Middle Aged
  • Peptides, Cyclic / immunology
  • Receptors, Tumor Necrosis Factor / therapeutic use
  • Rheumatoid Factor / blood


  • Adrenal Cortex Hormones
  • Antibodies, Anti-Idiotypic
  • Antibodies, Monoclonal
  • Antirheumatic Agents
  • Immunoglobulin G
  • Peptides, Cyclic
  • Receptors, Tumor Necrosis Factor
  • cyclic citrullinated peptide
  • Rheumatoid Factor
  • Infliximab
  • Matrix Metalloproteinase 3
  • Etanercept
  • Methotrexate