ARE THERE ANY DIFFERENCES RELATED TO THE AGE AT ONSET IN EARLY ARTHRITIS?

Background: Early arthritis (EA) represents an inflammatory arthritis with recent onset which do not fulfill the classification criteria for any definite rheumatological disorder. The disease course may be towards rheumatoid arthritis (RA), other rheumatic autoimmune diseases or towards remission. There is increasing evidence that early diagnosis and early aggressive treatment can limit RA progression and severity. The age and sex at disease onset may influence the disease activity and the evolution of EA. Objectives: This study aims to find possible differences related to the age at onset in EA, at the time of the first visit to the Rheumatologist. Methods: The study was conducted in the Rheumatology Department of a tertiary referral center in Romania between January 2009-December 2010. Patients between 18-65 years of age with arthritis of at least one peripheral joint less then 6 months duration were included in the study. Osteoarthritis, gout, recent trauma, definite connective tissue diseases, were excluded. Patients' medical history, objective physical status, joint examination with 28-swollen-joint count and 28-tender-joint count, patients' assessment of global disease activity on 100 mm VAS were recorded. General laboratory tests, immunological tests, musculoskeletal ultrasonography (US) were performed. Disease activity score 28 was calculated and medication was recorded. Patients were divided in two groups: less then 45 (group A) and over 45 years old (group B). Results: Each group included 26 patients. Clinical data related to the articular involvement were similar between the two groups, as well as the acute phase response markers. More patients in group A had rheumatoid factor negative compared to group B (p=0.05). Anti-cyclic citrullinated peptide antibodies were positive in 38% (A) and 69% of cases (B) (p=0.02). Abnormalities related to EA on musculoskeletal US were found in 53% (A) and 65% of patients (B). The ACR/EULAR classification criteria for RA 2010 were fulfilled in 38% (A) and 69% of cases (B), respectively (p=0.02). High disease activity scores had 42% (A) and 57% of patients (B). Treatment with Methotrexate was the first choice in 46% (A) and 80% of cases (B) (p=0.009). Conclusions: The new classification criteria for RA were more frequently fulfilled by patients with late onset EA. These patients also had more frequently markers for persistent and severe disease and higher disease activity scores at the time of diagnosis, as well as more early aggressive treatment, with possible implications for the disease course. Further studies on larger series of patients are needed to extend the results. References: 1. Aletaha D, et al. 2010 Rheumatoid arthritis classification criteria an American College of Rheumatology/Eular league Against Rheumatism collaborative initiative. Arthritis Rheum 2010 Sep; 62(9):2569-81 2. Diaz FJ, et al. Anti CCP antiboidies are asociated with early age at onset in patients with rheumatoid arthritis. Joint Bone Spine 2010 Sep 29 3. Olivieri I et al. Late-onset rheumatoid arthritis and late-onset spondilarthritis. Clin Exp Rheumatol 2009 Jul-Aug;27 (4 Suppl 55):S139-45. Disclosure of Interest: None DeclaredCitation: Annals of the Rheumatic Diseases, volume 70, supplement 3, year 2011, page 583Session: Rheumatoid arthritis – comorbidity and clinical aspects (Poster Presentations )