The Analysis Of Clinical Features And Short-term Application Of Etanercept In The Elderly In A Follow-up Trial In Gansu Area

Objective:Our aim was to probe into to the clinical features,boratory tests,sonography,comorbidities and compare therapeutic effects and safety of biological disease modifying antirheumatic drugs(bDMARDs)amd conventional synthetic DMARD(cs DMARD)in elderly rheumatoid arthritis(RA)in a short-term follow-up investigation in Gansu area.Methods 1st part: 120 patients were included and divided into elderly-onset RA(EORA,age at disease onset>60)、non-elderly-onset RA(NEORA,age at disease onset<60,current age>60)and younger-onset RA(YORA current age<60),each with 40 patients.Clinical characteristics were compared among 3 groups.2nd part: 100 patients were included and divided into 5groups,EORA-bDMARDs(E-bD),NEORA-bDMARDs(NE-bD),EORA-cs DMARDs(E-cD),NEORA-cs D MARDs(NE-c D),YORA-bDMARDs(Y-bD),each with 20 patients.Effectiveness and safety of the therapy were compared among 5 groups.Results:1st part: There were more males,more large joints affected and higher smoking rates(EORA65%,NEORA32.5%,YORA15%)in the EORA(P<0.05).EORA had a higher number of comorbidities(such as anemia,hypertension,pulmonary interstitial changes,chronic obstructive pulmonary disease,cardiovascular disease,thyroid dysfunction and rash)(P<0.05).Though EORA had more prevalence of radiographic erosions detected by ultrasonograph than YORA,there was no significant difference in disease activity between these two groups(P<0.05).There is a significant correlation between sonographic findings about YORA patients with hyperplasia of synovial membrane and disease activity(r=0.460,P<0.01).Sacroiliac joint might be involved in NEORA with long disease duration(P<0.05)and temporomandibular joint involvement was more common in both NEORA and YORA(P<0.01).The usage rate of glucocorticoid was higher in EORA(EORA60%,NEORA60%,YORA32.5%)and NEORA while lower rate of bDMARDs was found in EORA(EORA22.5%,YORA47.5%),P<0.05.2nd part: After 4 weeks following-up,there was a decrease in joint pain counts(E-bD9.30±7.09,NE-bD7.15±6.68,Y-bD8.00±4.35,P<0.05),ESR(E-bD24.90±22.34,NE-bD26.15±22.33,Y-bD29.00±17.88,P<0.05)and disease activity,in E-bD,NE-bD,Y-bD groups,especially in Y-bD(E-bD1.87±1.34,E-cD1.42±0.76,NE-bD1.98±1.32,NE-c D1.06±0.81,Y-bD2.13±1.10,P>0.05),however,the difference was not statistically significant.Data followed for 4 weeks showed a larger drop of disease activity in E-bD and NE-bD groups than in E-cD and NE-cD groups,P<0.05.After a median follow-up period of 8 weeks,the indicators of E-cD and NE-c D groups declined compared with the baseline,but it was not statistically significant between these 2 groups(P>0.05).The use of biological agents and cs DMARDs carried a similar infection risk between EORA and NEORA(P>0.05).It seemed Y-bD group had fewer adverse reactions than E-bD,NE-bD,but differences were no significant(P>0.05).The adverse reactions had not statistical difference between EORA and NEORA whatever the treatments was.Conclusion 1st part: For those elderly men suffered from large joints pain,RA might be considered.For those diagnosed with EORA and NEORA,multi-aspect should be adopted while assessing the severity of disease,such as ultrasound examination,clinical manifestations and serological results.EORA patients should be treated as soon as possible since they might have more joint erosions compared with YORA.Meanwhile EORA patients appeared to have higher comorbidity burden and those patients requires multidisciplinary care all the same.2nd part: It would be a longer time for E-bD,NE-bD to get remissions than Y-bD groups,meanwhile more untoward reaction might be found in E-bD,NE-bD groups.Biological agents had a similar therapeutic effect on E-bD and NE-bD regardless of the age at disease onset and course.Biologics has faster and better efficacy than csDMARDs in the same group,but there was no statistics significant of adverse reactions bwtween them.The incidence of adverse events was not associatedwith age at disease onset between E-c D and NE-cD groups.