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Age-related increases in erythrocyte sedimentation rate(ESR) and 28-joint swollen joint count (28-SJC) scores without relevantcorresponding increases in patient global assessment (PGA) and 28-joint tenderjoint counts (28-TJCs) may imply that age-related processes such asphysiological ESR increase and soft tissue changes contribute to a higher28-joint Disease Activity Score (DAS28) in older patients, according to resultsfrom a concise report published inRheumatology.

The current study used the DAS28 and its components to investigate the potential effect of aging on patients with rheumatoid arthritis who are nave to treatment with disease activity in disease-modifying antirheumatic drugs (DMARDs) from the Norwegian Register of DMARDs. Investigators used linear regression to explore associations between age (<45, 45-65, and >65 years) and each component of the DAS28 while accounting for sex and education. They calculated adjusted predicted scores for each component and total scores for each age range. Because significant interactions were found between age and sex for the 28-TJC, PGA, and ESR (P<.001), researchers stratified regression models for sex. Education was a signicant covariate, leading investigators to calculate predicted scores across age categories for different levels of education. Disease duration was not included in the model because it proved to not be a significant confounder.

Baseline data were available for 2037 patients (mean age55.2 years; 68% women). Compared with the youngest age group, men older than 65years with an intermediate education level had a 25% higher 28-SJC and 56%higher ESR, and women with an intermediate education level had a 27% higher28-SJC and 51% higher ESR. The differences between 28-TJC and PGA werenegligible (men: 28-TJC 3% and PGA 1%; women: 28-TJC 1% and PGA 2%). Thedifference in total DAS28-ESR score between the youngest and oldest agecategory was 10% for both men and women. In absolute values, the DAS28 was 5.5in the oldest group compared with 5 in the youngest.

Study limitations included using baseline data from patientswho were DMARD-nave entering the Norwegian Register of DMARDs and thepotential for confounding variables; however, the study investigators concludedthat the present study indicates that age has a significant positiverelationship with the DAS28-ESR, with the ESR and 28-SJC driving the increase.Validation of disease activity measures in elderly RA patients should be performedin future studies where the influence of comorbidity and physiologicalageingis studied. The age effect on DAS28 might be relevant in atreat-to-target strategy, but longitudinal data are needed to further explorethis.

Reference van Onna M, Putrik P, Lie E, Kvien TK, Boonen A, Uhlig T.What do we measure with 28-joint DAS in elderly patients? An explorative analysis in the NOR-DMARD study[published online October 26, 2019].Rheumatology (Oxford). doi:10.1093/rheumatology/kez490

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Effect of Aging on 28-Joint Disease Activity Score in Rheumatoid Arthritis - Rheumatology Advisor

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