Lower ratings of pain intensity in older adults lead to underestimation of disease activity in patients with rheumatoid arthritis
Journal Title: International Journal of Clinical Rheumatology - Year 2017, Vol 12, Issue 2
Abstract
Background: To investigate the influence of age on the components of the 28-joint Disease Activity Score (DAS28)-C-Reactive Protein (CRP) in patients with Rheumatoid Arthritis (RA) and whether DAS28-CRP can be equally interpreted in all age groups. Methods: The proportion of CRP and patient reported components of the DAS28 (DAS-P) were analyzed and compared between 2 age groups (younger RA <60, older RA ≥ 60) using Mann-Whitney U test. Inflammatory disease burden in the joint was calculated by modified DAS28 (MDAS28=0.49 x ln(C-Reactive Protein (CRP))+0.15 x swollen joint count 28+0.22 x physician global assessment (PhGA)+1). Multivariate analyses were used to design models best predicting the effect of age on CRP, the proportion of CRP, inflammation level calculated by MDAS28, DAS-P, and pain levels. Results: CRP and the proportion of CRP in DAS28-CRP were not influenced by age. MDAS28 did not increase with age but was associated with disease duration and anti-tumor necrosis factor (TNF) therapy. DAS-P and pain level had significant negative association with age. In subjects with moderate inflammation (defined by MDAS28 score above 50 percentile, N=370), older RA subjects (N=189) had lower pain level, tender joint count, patient and physician global assessment, DAS28-CRP than younger subjects (n=157). Conclusions: CRP, proportion of CRP in DAS28-CRP, and MDAS28 were not influenced by age but the proportion of subjective components of DAS28-CRP and pain level decreased with age. Therefore, disease activity could be underestimated by DAS28-CRP in older RA patients.
Authors and Affiliations
Yong Gil Hwang, Ajay D Wasan, June Feng, Heather Eng, Jason Lyons, Anthony Fabio, Larry W Moreland
Keywords
Related Articles
- EP ID EP603276
- DOI -
- Views 59
- Downloads 0
Clinical, ultrasonographic and multidetector computed tomography features of temporomandibular joint in rheumatoid arthritis and psoriasis patients
Background: The incidence of Tempro Mandibular Joint (TMJ) involvement in inflammatory arthritis is underestimated. It is more common in Rheumatoid Arthritis (RA) than in Psoriatic Arthritis (PsA). TMJ affection could pr...
PTPN22, CTLA4, FcγRIIa, FcγRIIIa and FcγRIIIb polymorphisms in Tunisian patients with systemic lupus erythematosus
Background: Pathogenesis of systemic lupus erythematosus (SLE) involves both T cell tolerance breakdown and pathogenic autoantibodies. Polymorphisms in T cell regulatory proteins (PTPN22 and CTLA-4) and IgG receptors (Fc...
Predictive value of rheumatoid factor titre in cryoglobulinemia in Hepatitis C positive patients
Background/objective: HCV viremia has been known to provoke a plethora of autoimmune syndromes as well as nonspecific rheumatologic manifestations. HCV is the most frequent cause of mixed cryoglobulinemia, which is chara...
Increased prevalence of ANA and Anti-SSA in African American rheumatoid arthritis patients is not associated with increased serum chemokine concentrations
Background: African American (AA) rheumatoid arthritis (RA) patients have increased disease activity compared to Caucasian (CAU) RA patients. Serum chemokines, such as CXCL10, are increased in RA patients and may functio...
Disease flares, damage accrual and survival in ANCA-associated vasculitis in Western Australia
Background: ANCA-associated vasculitis (AAV) is a potentially life-threatening condition for which limited Australian data are available. We investigated the clinical and epidemiological outcomes of AAV in the last decad...