title: Observational cross-sectional study revealing less aggressive treatment in Japanese elderly than nonelderly patients with rheumatoid arthritis.
abstract: BACKGROUND
  Elderly patients with rheumatoid arthritis (RA) have more aging-related complications than nonelderly patients with RA.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan. miogasaw@juntendo.ac.jp
authors.forename: Michihiro
authors.initials: M
authors.lastname: Ogasawara
authors.forename: Naoto
authors.initials: N
authors.lastname: Tamura
authors.forename: Shin
authors.initials: S
authors.lastname: Onuma
authors.forename: Makio
authors.initials: M
authors.lastname: Kusaoi
authors.forename: Fumio
authors.initials: F
authors.lastname: Sekiya
authors.forename: Ran
authors.initials: R
authors.lastname: Matsudaira
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kempe
authors.forename: Ken
authors.initials: K
authors.lastname: Yamaji
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Takasaki
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D000888:Antibodies, Anti-Idiotypic / Q000097:blood; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D019278:Matrix Metalloproteinase 3 / Q000097:blood; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012217:Rheumatoid Factor / Q000097:blood
chemical_list: D000305:Adrenal Cortex Hormones; D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D010456:Peptides, Cyclic; D018124:Receptors, Tumor Necrosis Factor; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor; D000069285:Infliximab; D019278:Matrix Metalloproteinase 3; D000068800:Etanercept; D008727:Methotrexate