Year: 2025
Type: letter
Abstract: We appreciate Togizbayev et al for initiating a timely discussion on the classification of late-onset rheumatoid arthritis (LORA).The letter raises essential questions regarding terminology (LORA vs elderly-onset rheumatoid arthritis [EORA]), age thresholds for identification (60 vs 65 years), and the need for specific management and classification criteria for older adults with RA.Addressing these issues will lay the foundation for more precise classification criteria and treatment pathways for older adults with LORA, a population for whom undertreatment remains a persistent concern. 1 We agree that the term "LORA" is more appropriate than EORA, as language related to aging has evolved and aligns with emerging guidelines from international bodies, including the World Health Organization, American Geriatrics Society, and Japanese College of Rheumatology.[2][3][4] Additionally, we support the use of age 65 years as the diagnostic cutoff, which is widely accepted as the definition of aging in higher-income countries, where the population of older adults with rheumatoid arthritis (RA) is expanding most rapidly.However, although this threshold is a practical diagnostic standard, it does not fully capture the heterogeneity of aging and its implications for LORA management and classification.To address these limitations, we propose integrating a more nuanced consideration of age along with geriatric principles and assessments, which are essential components for capturing the complex health profiles of older adults with LORA.By integrating chronological age with geriatric assessments, such as frailty and multimorbidity, age-friendly frameworks can provide more relevant and actionable criteria.Stratifying older adults into youngest-old (65-74 years), middle-old (75-84 years), and oldest-old (85+ years) subgroups or categorizing them as prefrail or frail may facilitate more tailored treatment approaches.5,6 This structure enables clinicians to distinguish differences in biologic, psychologic, and social aging, allowing treatment strategies to be more precisely aligned with specific health profiles.Additionally, integrating functional status assessments can identify older adults at higher risk for adverse outcomes, informing opportunities for interventions to mitigate risks.Although these refinements can improve classification and personalization of care, a more fundamental challenge lies in the lack of targeted evidence to guide treatment decisions and inform Vol. 7, No. 6,
Source: ACR Open Rheumatology
DOI: 10.1002/acr2.70084
Authors: Jiha Lee, Una E. Makris
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,550
OpenAlex ID: W4411532015