TOPLINE

Among patients with newly diagnosed rheumatoid arthritis (RA) who were managed with a standardised treat-to-target (T2T) strategy, those with elderly-onset disease had similar disease activity and safety profiles to those with young-onset disease, required less intensive therapy, and were more likely to be off disease-modifying antirheumatic drugs (DMARDs) at 2 years.

METHODOLOGY

• Researchers in Netherlands conducted a post hoc analysis of a multicentre randomised trial (tREACH) to determine whether a standardised T2T strategy was feasible and safe in patients with elderly-onset RA (onset > 65 years) vs those with young-onset RA (onset, 18-65 years).
• The analysis included 425 patients with RA who met the 1987 and/or 2010 classification criteria for RA, of whom 98 had elderly-onset RA (mean age, 73 years; 50% men) and 327 had young-onset RA (mean age, 48 years; 28% men).
• All patients were managed using a T2T protocol that used medications alone or in combination to achieve low disease activity, defined as a disease activity score based on 44 swollen and 53 tender joint counts (DAS44) ≤ 2.4.
• Treatment was escalated from conventional to biologic DMARDs when treatment targets were not achieved, and DMARD tapering was initiated after sustained remission according to a predefined protocol.
• Outcome measures over 2 years included disease activity, rates of active disease and sustained remission, medication use, DMARD-free remission, difficult-to-treat RA, and adverse events.

TAKEAWAY

• DAS44 followed similar trajectories in elderly‑onset and young‑onset RA; differences in active disease and sustained remission did not reach statistical significance.
• Fewer patients with elderly-onset vs younger-onset RA ever initiated biologic DMARDs. At 24 months, the use of biologic DMARDs remained lower in those with elderly-onset RA (15% vs 30%; P < .05), and difficult-to-treat disease was uncommon in both groups.
• At 24 months, a higher proportion of patients with elderly-onset vs younger-onset RA were off DMARD therapy (33% vs 20%; P = .01) and had more visits involving medication tapering (34% vs 23%; P < .05).
• Rates of serious adverse events and treatment adjustments for adverse events were similar between the two groups. Bone marrow suppression and elevated serum creatinine levels were more commonly reported in patients with elderly-onset RA, and headache, fatigue, and low mood were reported often by patients with younger-onset disease.

IN PRACTICE

"Despite ageing-related pharmacokinetic and pharmacodynamic changes, patients with elderly-onset RA demonstrated similar adherence to a T2T approach as those with YORA [young-onset RA], while maintaining a reassuring risk-benefit profile. These findings support implementing T2T strategies in patients with EORA [elderly-onset RA] whenever clinically applicable," the authors wrote.

SOURCE

This study was led by Hamit Harun Dag, Erasmus MC, Rotterdam, Netherlands. It was published online on July 03, 2026, in RMD Open.

LIMITATIONS

The researchers could not fully exclude a healthy volunteer effect. Misdiagnosis, particularly in autoantibody-negative cases, could not be ruled out because inflammatory osteoarthritis might resemble the elderly-onset disease. Missing data after 18 months may have affected the precision of later estimates.

DISCLOSURES

The authors did not report any specific funding. Several authors reported receiving research grants, consultancy fees, or personal fees from multiple pharmaceutical companies and other organisations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.