#2-72E. Optimizing Elderly-Onset RA Management: Achieving T2T with Less bDMARDs (Rheumatol, 2025)

For rheumatologists, managing elderly-onset rheumatoid arthritis (EORA) often presents a dilemma: should we aim for the same aggressive Treat-to-Target (T2T) goals as younger patients, despite the presence of multiple comorbidities? This study, utilizing data from the tREACH trial, investigated clinical and patient-reported outcomes (PROs) over two years among young-onset (YORA), middle-aged (MORA), and EORA patients (age >65) managed using a structured T2T approach. The analysis revealed that despite EORA patients presenting with more erosions, swollen joints, and comorbidities at diagnosis, their disease activity remained comparable to younger cohorts throughout the follow-up period. Crucially, the study found that EORA patients required significantly less bDMARD usage (15%) compared to YORA and MORA patients (30%) to achieve the same low disease activity targets, suggesting that less intensive therapy may be sufficient in this population. However, clinicians should consider the limitation that the EORA cohort was somewhat underrepresented compared to the general RA population, which may affect the generalizability of the findings. These results reinforce the importance of aggressively applying T2T strategies in EORA patients regardless of comorbidities, while guiding individualized treatment choices that may necessitate fewer biologic therapies.

Citation: Dag HH, Snoeck Henkemans SVJ, Looijen AEM, Heutz JW, Dolhain RJEM, de Jong PHP. Eye-openers for advanced management of elderly-onset rheumatoid arthritis. Rheumatology. 2025. DOI: 10.1093/rheumatology/keaf432

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