Influence of age and sex on functional outcome over time in a cohort of patients with recent‐onset inflammatory polyarthritis: Results from the Norfolk arthritis register

Abstract

Objective. It has been found that women with rheumatoid arthritis (RA) have a poorer prognosis than men. However, the impact of age at symptom onset is unclear. We investigated the relationship between these factors and functional disability in patients with recent-onset inflammatory polyarthritis (IP). Methods. A total of 3,666 patients (66% women) were registered with the Norfolk Arthritis Register between 1990 and 2008. Functional disability was assessed using the Health Assessment Questionnaire (HAQ), adjusted for age at HAQ completion. Linear random-effects models were used to examine HAQ score over time, by sex and age at symptom onset (early ‫؍‬ age <55 years, late ‫؍‬ age 55-74 years, very late ‫؍‬ age >75 years). Results. Women had higher HAQ scores over time than men (mean difference 0.29; 95% confidence interval [95% CI] 0.25, 0.34). Men with late-onset IP had lower baseline HAQ scores than men with early onset (mean difference ؊0.14; 95% CI ؊0.29, ؊0.001). Women had comparable baseline HAQ scores at all ages of onset. Both sexes showed the greatest rate of disability progression in patients with very late onset. Those with early onset had a steady level of disability over time. Adjustment for treatment received, comorbidities, and RA subgroup analysis produced results that were largely similar to the initial analysis. Conclusion. Female patients have higher HAQ scores than male patients; patients with early symptom onset show the smallest sex difference. Older age at symptom onset is associated with an increasingly steep trajectory of disability progression. The impact of sex on outcome is evident at baseline, whereas the impact of age at symptom onset becomes apparent during long-term followup.

The influence of age at disease onset on disease activity and disability: results from the Ontario Best Practices Research Initiative

“…Our findings are comparable to other studies showing a lower female predominance and less seropositivity in LORA [3,6,8,11,12]. This contrasts previous evidence of elevated RF titers due to increasing age alone; however, seroconversion over time is possible and was not formally assessed in this study [14].…”

“…Greater disability has been noted in other studies of LORA [5,7,11,12]. In a study of 1809 early RA patients from Canada, which closely resembles our study population, LORA patients were found to start and end their first year of disease with higher HAQ scores, suggesting that a difference due to age persists over time [6].…”

“…The degree of joint damage has been shown to be higher in LORA, while others report no difference in radiographic progression between YORA and LORA patients [4,[7][8][9][10]. Varied results are noted when disease severity is defined in terms of disability, as measured using the Health Assessment Questionnaire (HAQ) [3,6,7,[9][10][11][12]. Additionally, the types of therapy selected and the effect of treatment influencing these outcomes may differ according to an individual's age at the time of RA onset [5,13].…”

Validation of the Inflammatory Bowel Disease Disability Index in a population-based cohort

“…In a population-based cohort (n=3666) of patients with inflammatory polyarthritis, women had worse HAQ scores than men 35. Similarly, in a European MS cohort I of 1992 patients, a multivariate multiple regression analysis found that female gender was significantly associated with a lower Physical SF-36 index and higher disability level 36…”

An Overview of Late-onset Rheumatoid Arthritis

“…[7] Moreover, most LORA patients also have comorbid diseases and additional inflammatory diseases that increase the level of functional impairment, which was already not acceptable. Rheumatoid arthritis mostly coexists with osteoarthritis (OA), and both decrease the quality of life (QoL).…”