Impact of age on rheumatoid arthritis: disease activity may be masked by lower pain in older people

Lower levels of perceived pain may cause underestimation of disease activity in older people with rheumatoid arthritis, says a team from the University of Pittsburgh.
The scientists split 740 people with rheumatoid arthritis into groups: people younger than 60 years and people aged 60 years and older. Average age was 61 years and disease duration was 14 years.

They found that pain levels negatively correlated with age after researchers adjusted their findings for gender, race, comorbidities and inflammation.
The 189 participants with moderate inflammation who were older than 60 years had a higher number of swollen joints yet had lower levels of pain, tender joints, patient global assessment scores, physician global assessment scores and standard measures of disease activity compared with younger people.

Physical health did not differ between groups. Mental health scores were higher in the older group. People with disease activity beneath the 50th percentile had no differences based on age.

“Decreased pain level in older rheumatoid arthritis patients with a similar degree of joint inflammation as younger rheumatoid arthritis patients leads to underestimation of disease activity measured by either patient-reported outcome (RAPID3) or composite disease activity index (DAS28-CRP),” the researchers wrote. “This suggests that current clinical disease activity measurements may not fully reflect the severity of disease in older rheumatoid arthritis patients.”

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Image credit: greybeard39