Comparison of Time to Remission in Treatment Regimen at Remission between Late Onset Rheumatoid Arthritis (LORA) and Early Onset Rheumatoid Arthritis (EORA) Patient

Ishwah Akram; Muhammad Zubair; Syeda Kinza Bukhari; Fahad Ahmad Khan; Aima Maheen; Hasaan Ijaz

doi:10.70749/ijbr.v3i5.1205

Authors

Ishwah Akram Department of Medicine, Combined Military Hospital, Multan, Punjab, Pakistan.
Muhammad Zubair Department of Medicine, Combined Military Hospital, Multan, Punjab, Pakistan.
Syeda Kinza Bukhari Department of Medicine, Combined Military Hospital, Multan, Punjab, Pakistan.
Fahad Ahmad Khan Department of Medicine, Combined Military Hospital, Multan, Punjab, Pakistan.
Aima Maheen Bakhtawar Amin Medical and Dental College, Multan, Punjab, Pakistan.
Hasaan Ijaz Department of Medicine, Combined Military Hospital, Multan, Punjab, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i5.1205

Keywords:

Methotrexate, Remission, Rheumatoid Arthritis, Tofacitinib

Abstract

Objectives: To compare the time to remission and treatment regimen at remission between late onset rheumatoid arthritis (LORA) and early onset rheumatoid arthritis (EORA) patients. Study design: Prospective cohort study. Place of duration of study: Department of Medicine, CMH, Multan from July 2023 to December 2024. Methods: A total of 670 patients with an age of onset of active RA ≥ 60 years, diagnosed within 1 year, were included in the LORA group. Other 670 patients with age of onset of active RA between 18-59 years with similar diagnostic details were included in the EORA group. Disease activity was evaluated using the DAS -ESR 28 score. Patients initiated methotrexate (5-15mg/week, maximum 25mg/week). Upon inadequate response to optimal therapy, (DAS28-ESR ≥ 2.6 after 3-6 months), tofacitinib (5mg twice daily) was added to methotrexate or used as monotherapy in intolerant cases, following treat-to-target strategy. The primary outcomes were set as DAS28-ESR scores, proportion of patients achieving remission (DAS28-ESR < 2.6) at 12 months, time to first remission, and treatment regimens at remission. Results: The mean age of patients was 68.35±5.99 and 49±5.89 years in group LORA and group EORA respectively. LORA patients were more frequently on methotrexate monotherapy (p=0.04) or methotrexate + tofacitinib combination (0.004) than EORA patients. There was no statistically significant difference in the two groups in DAS28-ESR score achieved and the number of patients achieving DAS28-ESR ˂2.6 at the completion of study. Comparison of time to remission in patients achieving remission also showed no statistically significant difference among the two groups (p=0.5). Conclusion: The remission rate and time to remission remains similar in LORA and EORA patients despite the differences in medication regimens to achieve remission.

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