Late-onset rheumatoid arthritis: Justifying the need for international practice guidelines and classification criteria

Chokan Baimukhamedov, Marina Baimukhamedova

2024

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DOI 10.1093/mr/roae117
Data confidence 70 medium
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Abstract

Dear Editor! We read with great interest a Consensus statement on initial treatment of late-onset rheumatoid arthritis (LORA) drafted by experts of the Japanese College of Rheumatology [1]. This much-awaited initiative will have clinical and ethical implications worldwide and will be appreciated by rheumatologists and geriatricians encountering older patients with rheumatoid arthritis (RA) and comorbidities. The issue of LORA has been explored in the literature over the past seven decades, although no generally accepted definitions, classification criteria, and recommendations for diagnosis and treatment have been formulated since the initial report [2]. The Consensus justifies the importance of action points in view of the increasing cases of RA onset at the age of 65 years and advocates for the term LORA. As of 7 November 2024, PubMed searches with the term LORA allowed retrieving 428 bibliographic records, whereas the same searches with the term elderly-onset RA (EORA) resulted in 4305 records. Despite the much wider acceptance of the term EORA, referring it as an entity of elderly subjects does not sound ethical [3]. Moreover, age thresholds of the entity vary across published reports. While most studies examine patients >60 years, the Consensus considers an age threshold of 65 years. Understandably, the latter approach is more acceptable in the context of an ageing society [4]. In fact, the latest analysis, based on the National Database of Rheumatic Diseases in Japan (NinJa), suggests that subjects >65 years are more frequently diagnosed with RA and live longer due to improved diagnosis and treatment [5].