Abstract
To the Editor:We carefully reviewed the recent article by Lee et al 1 on late-onset rheumatoid arthritis (LORA) treatment.As the global population ages, the incidence of rheumatoid arthritis (RA) onset after the age of 65 is increasing.However, challenges remain owing to the lack of standardized terminology, clearly defined age thresholds, established classification criteria, and comprehensive international guidelines.The article employs the term "late-onset rheumatoid arthritis."A PubMed search revealed that 261 articles include this term, whereas "elderly-onset rheumatoid arthritis" (EORA) appeared in 4,839 results (as of March 24, 2025).However, the terms "elderly" and "aged" are discouraged in medical writing, as highlighted by the American Medical Association.2 The spelling "late onset rheumatoid arthritis" (without the hyphen) is more common than the hyphenated form.The guidelines of the Japan College of Rheumatology, 3 currently the only national guidelines on this topic, recommend using LORA instead of EORA.Given these inconsistencies, it is essential to establish a unified terminology.It is also important to distinguish RA that develops at an older age (LORA or EORA) from RA that persists into an older age (young-onset RA [YORA]).With advances in treatment strategies such as treat-to-target, more patients with YORA are reaching an older age, further complicating the classification.Another major inconsistency concerns the age threshold used to define LORA and EORA.The World Health Organization classifies individuals aged 60 to 74 years as "elderly," suggesting that age 60 may be the most appropriate cutoff for LORA or EORA.Most studies have used this threshold.4 However, the article in American College of Rheumatology (ACR) Open Rheumatology 1 uses 66 years, whereas the Japanese guidelines 3 and many other sources defined it as 65 or 66 years.In the United States of America, Medicare eligibility begins at age 65, whereas individuals aged 60 to 64 years may be enrolled in commercial insurance or Medicaid or may be uninsured.Existing rheumatic disease registries are not designed to specifically identify LORA and often lack sufficient sample size or statistical power to support meaningful analyses in this population.This limitation underscores the need for a consensus definition to guide harmonized data collection and facilitate more robust, generalizable research.We think the best age threshold is 65 years, but it needs discussion (ACR Open Rheumatology and the ACR Convergence 2025 might be the best place for that).