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Treatment-resistant synovitis and radiographic progression are increased in elderly-onset rheumatoid arthritis patients : findings from a prospective observational longitudinal early arthritis cohort study

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dc.contributor.authorRomão, Vasco C.
dc.contributor.authorHumby, Frances
dc.contributor.authorKelly, Stephen
dc.contributor.authorDi Cicco, Maria
dc.contributor.authorMahto, Arti
dc.contributor.authorLazarou, Ilias
dc.contributor.authorHands, Rebecca
dc.contributor.authorRocher-Ros, Vidalba
dc.contributor.authorvan der Heijde, Désirée
dc.contributor.authorFonseca, João Eurico
dc.contributor.authorPitzalis, Costantino
dc.date.accessioned2021-03-04T17:21:53Z
dc.date.available2021-03-04T17:21:53Z
dc.date.issued2020
dc.description© 2020 Elsevier Inc. All rights reservedpt_PT
dc.description.abstractBackground: Clinical outcomes in elderly-onset rheumatoid arthritis (EORA), starting after the age of 60, are conflicting. Thus, we aimed to investigate in a unique biopsy-driven, treatment-naïve early arthritis cohort, the relationship between synovial pathobiology of elderly- (EORA) and younger-onset rheumatoid arthritis (YORA) patients through clinical, imaging and treatment response outcome-measures. Methods: Patients (n = 140) with early RA (<12months) starting before (YORA, n = 99) or after (EORA, n = 41) age 60 had an ultrasound-guided synovial biopsy prior to conventional immunosuppressive therapy and after 6 months. Clinical, ultrasound and radiographic data were collected prospectively and compared between groups and against immunohistological features. Using multivariate logistic regression, we determined predictors of clinical response (disease activity score-28-erythrocyte sedimentation rate [DAS28-ESR]<3.2) at 6 months and radiographic progression ( 1-unit-increase in Sharp van der Heijde [SvdH] score) at 12 months. Results: EORA patients were more frequently male and presented most commonly with an abrupt, polymyalgia rheumatica-like onset and extra-articular features. Both before and after treatment, DAS28-ESR was similar but ultrasound synovial-thickening (p<0.05) and power-Doppler (p<0.01) synovitis and SvdH (p<0.001) scores were higher in EORA patients. EORA was independently associated with poor treatment response at 6 months (OR=0.28, p = 0.047) and radiographic progression at 12 months (OR=4.08, p = 0.029). Synovial pathotype, synovitis scores and cellular infiltration were similar before treatment, but a pauci-immune-fibroid pathotype tended to be more common in YORA at 6 months (p = 0.093). Moreover, YORA patients had a marked improvement of all synovitis parameters (p<0.001), whereas EORA presented only mild decreases in synovitis (p<0.05), sublining macrophage (p<0.05) and T cell scores (p<0.05), with no significant changes in lining macrophages, B cells or plasma cells. Conclusion: Early EORA presents differently and has a worse overall prognosis than YORA, with poorer clinical, histological, ultrasonographic and radiographic outcomes.pt_PT
dc.description.sponsorshipThis work was supported by the Medical Research Council (grant number 36661, to PEAC); Arthritis Research UK (now Versus Arthritis; Experimental Arthritis Treatment Centre Grant, number 20022, to Centre for Experimental Medicine and Rheumatology); Fundação para a Ciência e Tecnologia (Interno Doutorando Bursary reference SFRH/SINTD/95030/2013, to VCR); European League Against Rheumatism (EULAR Scientific Training Bursary 2014, to VCR); and Sociedade Portuguesa de Reumatologia (Fundo de Apoio à Investigação da SPR 2015, to VCR).pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationSemin Arthritis Rheum. 2020 Aug;50(4):735-743pt_PT
dc.identifier.doi10.1016/j.semarthrit.2020.03.018pt_PT
dc.identifier.eissn1532-866X
dc.identifier.issn0049-0172
dc.identifier.urihttp://hdl.handle.net/10451/46662
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.relationSYNOVIAL PATHOBIOLOGY AND PATIENT STRATIFICATION IN RHEUMATOID ARTHRITIS
dc.relation.publisherversionhttps://www.sciencedirect.com/journal/seminars-in-arthritis-and-rheumatismpt_PT
dc.subjectRheumatoid arthritispt_PT
dc.subjectElderly-onsetpt_PT
dc.subjectSynovitispt_PT
dc.subjectSynovial pathobiologypt_PT
dc.subjectRadiographic progressionpt_PT
dc.titleTreatment-resistant synovitis and radiographic progression are increased in elderly-onset rheumatoid arthritis patients : findings from a prospective observational longitudinal early arthritis cohort studypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.awardTitleSYNOVIAL PATHOBIOLOGY AND PATIENT STRATIFICATION IN RHEUMATOID ARTHRITIS
oaire.awardURIinfo:eu-repo/grantAgreement/FCT//SFRH%2FSINTD%2F95030%2F2013/PT
oaire.citation.endPage743pt_PT
oaire.citation.issue4pt_PT
oaire.citation.startPage735pt_PT
oaire.citation.titleSeminars in Arthritis and Rheumatismpt_PT
oaire.citation.volume50pt_PT
person.familyNameC Romão
person.familyNameFonseca
person.givenNameVasco
person.givenNameJoão
person.identifier490119
person.identifier.ciencia-id771D-0A5C-626B
person.identifier.ciencia-idF310-B85D-57C7
person.identifier.orcid0000-0002-5603-9436
person.identifier.orcid0000-0003-1432-3671
person.identifier.ridO-8224-2014
person.identifier.scopus-author-id55989452300
person.identifier.scopus-author-id7101983519
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.nameFundação para a Ciência e a Tecnologia
rcaap.rightsrestrictedAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublicatione7e94139-add7-4a3b-b138-fb1d1a656b0e
relation.isAuthorOfPublication1772dc12-7c55-4c76-ae2d-c23270172480
relation.isAuthorOfPublication.latestForDiscoverye7e94139-add7-4a3b-b138-fb1d1a656b0e
relation.isProjectOfPublication19261111-c899-4b70-b891-50aab0ec00c4
relation.isProjectOfPublication.latestForDiscovery19261111-c899-4b70-b891-50aab0ec00c4

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