title: Structural and functional outcomes of a therapeutic strategy targeting low disease activity in patients with elderly-onset rheumatoid arthritis: a prospective cohort study (CRANE).
abstract: OBJECTIVE
  The aim of this study was to evaluate structural damage and physical disability in patients with elderly-onset RA (EORA) who were treated in clinical practice with a therapeutic strategy targeting low disease activity (LDA).
  
  
  METHODS
  Data from 151 MTX-naive patients (mean age 74.9 years) with EORA from a prospective, monocentric registry were analysed. Treatment was adjusted every 3 months targeting LDA [28-joint DAS using ESR (DAS28-ESR) <3.2]. Treatment was initiated with non-biologic DMARDs (nbDMARDs), followed by TNF inhibitors (TNFis) or tocilizumab. The primary outcome was change from week 0 to week 52 in the modified total Sharp score (ΔmTSS). Secondary outcomes were derived from the HAQ Disability Index (HAQ-DI) and DAS28 at week 52. Predictors of clinically relevant radiographic progression [CRRP; ΔmTSS/year more than the smallest detectable change (2.1 points)] were examined using multivariate logistic regression models.
  
  
  RESULTS
  Adherence to the treat-to-target strategy was observed in 83.4% of the 151 patients at week 24 and in 75.5% at week 52. At week 52, 67.6% of the patients were receiving a nbDMARD alone, 31.0% a TNFi with or without MTX and 1.4% tocilizumab. At week 52, structural remission (ΔmTSS/yr ≤0.5) was achieved in 49.7% of the patients, functional remission (HAQ-DI ≤0.5) in 63.4% and LDA in 51.0%. Clinical responses at weeks 12 and 24 were significant independent predictors of CRRP. Cumulative disease activity during the first 12 weeks predicted CRRP with a C-statistic of 0.888.
  
  
  CONCLUSIONS
  Achieving structural remission, functional remission and LDA in clinical practice in EORA patients are realistic goals. Our results indicate significant benefits for a therapeutic strategy targeting LDA for EORA patients in clinical practice.
authors.affiliation: Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan takahiko_sugihara@tmghig.jp.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Sugihara
authors.affiliation: Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Ishizaki
authors.affiliation: Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Hosoya
authors.affiliation: Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Shoko
authors.initials: S
authors.lastname: Iga
authors.affiliation: Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Waka
authors.initials: W
authors.lastname: Yokoyama
authors.affiliation: Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Hirano
authors.affiliation: Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Miyasaka
authors.affiliation: Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Department of Medicine and Rheumatology and Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Harigai
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000453:epidemiology; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D010349:Patient Compliance; D011446:Prospective Studies; D011859:Radiography; D012042:Registries; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; C502936:tocilizumab
keywords: clinical practice; elderly-onset RA; functional remission; structural remission; treat to target