Late-onset versus young-onset rheumatoid arthritis: comorbidities, disease activity, and treatment patterns in a nationwide real-world registry from Kuwait.
8 affiliations
- 1Rheumatology Department, Sabah Hospital, Kuwait, Kuwait.
- 2Rheumatology Department, Farwaniya Hospital, Kuwait, Kuwait.
- 3College of Business and Economics, American University of Kuwait, Kuwait, Kuwait.
- 4Rheumatology Department, Amiri Hospital, Kuwait, Kuwait.
- 5Department of Medicine, Kuwait University, Kuwait, Kuwait.
- 6Rheumatology Department, Mubarak Al-Kabeer Hospital, Kuwait, Kuwait.
- 7Rheumatology Department, Adan Hospital, Kuwait, Kuwait.
- 8Rheumatology Department, Jaber Hospital, Kuwait, Kuwait.
Abstract
Objectives
Late-onset rheumatoid arthritis (LORA) may differ clinically from young-onset rheumatoid arthritis (YORA), but real-world data from the Middle East and North Africa are limited. We compared characteristics, comorbidities, disease activity, and treatment patterns between LORA and YORA in the Kuwait Registry for Rheumatic Diseases (KRRD) and assessed whether age at onset was independently associated with disease activity.Methods
This retrospective analysis of prospectively collected KRRD data included patients with RA enrolled between January 2012 and April 2026. Patients were classified as YORA (symptom onset 18-59 years) or LORA (≥60 years). Baseline characteristics, disease activity, treatments, and one-year outcomes were compared. Multivariable logistic regression examined factors associated with moderate-to-high disease activity (DAS28-ESR ≥3.2). Sensitivity analyses additionally adjusted for current age, assessed collinearity, and repeated comorbidity and ESR comparisons after age adjustment and within patients aged 60-79 years.Results
Among 2,629 patients, 303 (11.5%) had LORA and 2,326 (88.5%) had YORA. LORA patients had shorter disease duration (2.9 ± 4.0 vs. 5.0 ± 7.1 years; p < 0.001) and higher comorbidity burden (2.0 ± 1.5 vs. 0.9 ± 1.2; p < 0.001). Most disease activity measures and treatment patterns were similar. Among 1,402 patients with follow-up of at least one year, disease activity at the last visit was similar (DAS28-ESR mean difference 0.10, 95% CI -0.12 to 0.30), including after inverse-probability weighting and multiple imputation. ESR was higher in LORA (40.9 vs. 33.3 mm/hr; p < 0.001), whereas CDAI was not (mean difference 0.7, 95% CI -0.9 to 2.3). Age at onset was not independently associated with moderate-to-high disease activity (adjusted OR 1.08, 95% CI 0.83-1.41; p = 0.559). After adjustment for current age and sex, the comorbidity excess in LORA was no longer evident (adjusted rate ratio 0.79, 95% CI 0.70-0.89), while ESR remained modestly higher (adjusted ratio 1.17, 95% CI 1.02-1.33). Adding current age did not materially change the onset-group estimate (adjusted OR 1.05, 95% CI 0.76-1.44).Conclusion
LORA and YORA showed similar disease activity, treatment patterns, and follow-up outcomes. The higher comorbidity burden in LORA was explained by chronological age, while ESR remained modestly elevated after age adjustment. Findings support treat-to-target principles regardless of age at onset, alongside management of comorbidities in older patients.
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BibTeX
@article{albasri2026lateonset,
title = {{Late-onset versus young-onset rheumatoid arthritis: comorbidities, disease activity, and treatment patterns in a nationwide real-world registry from Kuwait.}},
author = {Anwar Albasri and Ghaydaa Aldabie and Mohammad Khudadah and Ahmad Alsaber and Adeeba Al-Herz and Khuloud Mohammed and Adel Alawadhi and Eman Hasan and Waleed Alkandari and Aqeel Ghanem and Hoda Tarakmeh and Sawsan Hayat and Naser AlHadhood and Ammar Almathkouri and Ali Aldei and Hebah AlHajeri and Fatemah Baron and Amjad Alkadi and Dalal Alkhudir and Yaser Ali},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1972895},
url = {https://europepmc.org/article/MED/42922823},
note = {CC BY},
}
RIS
TY - JOUR
TI - Late-onset versus young-onset rheumatoid arthritis: comorbidities, disease activity, and treatment patterns in a nationwide real-world registry from Kuwait.
AU - Anwar Albasri
AU - Ghaydaa Aldabie
AU - Mohammad Khudadah
AU - Ahmad Alsaber
AU - Adeeba Al-Herz
AU - Khuloud Mohammed
AU - Adel Alawadhi
AU - Eman Hasan
AU - Waleed Alkandari
AU - Aqeel Ghanem
AU - Hoda Tarakmeh
AU - Sawsan Hayat
AU - Naser AlHadhood
AU - Ammar Almathkouri
AU - Ali Aldei
AU - Hebah AlHajeri
AU - Fatemah Baron
AU - Amjad Alkadi
AU - Dalal Alkhudir
AU - Yaser Ali
PY - 2026
DA - 2026/10/08
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1972895
UR - https://europepmc.org/article/MED/42922823
AB - Objectives Late-onset rheumatoid arthritis (LORA) may differ clinically from young-onset rheumatoid arthritis (YORA), but real-world data from the Middle East and North Africa are limited. We compared characteristics, comorbidities, disease activity, and treatment patterns between LORA and YORA in the Kuwait Registry for Rheumatic Diseases (KRRD) and assessed whether age at onset was independently associated with disease activity.Methods This retrospective analysis of prospectively collected KRRD data included patients with RA enrolled between January 2012 and April 2026. Patients were classified as YORA (symptom onset 18-59 years) or LORA (≥60 years). Baseline characteristics, disease activity, treatments, and one-year outcomes were compared. Multivariable logistic regression examined factors associated with moderate-to-high disease activity (DAS28-ESR ≥3.2). Sensitivity analyses additionally adjusted for current age, assessed collinearity, and repeated comorbidity and ESR comparisons after age adjustment and within patients aged 60-79 years.Results Among 2,629 patients, 303 (11.5%) had LORA and 2,326 (88.5%) had YORA. LORA patients had shorter disease duration (2.9 ± 4.0 vs. 5.0 ± 7.1 years; p < 0.001) and higher comorbidity burden (2.0 ± 1.5 vs. 0.9 ± 1.2; p < 0.001). Most disease activity measures and treatment patterns were similar. Among 1,402 patients with follow-up of at least one year, disease activity at the last visit was similar (DAS28-ESR mean difference 0.10, 95% CI -0.12 to 0.30), including after inverse-probability weighting and multiple imputation. ESR was higher in LORA (40.9 vs. 33.3 mm/hr; p < 0.001), whereas CDAI was not (mean difference 0.7, 95% CI -0.9 to 2.3). Age at onset was not independently associated with moderate-to-high disease activity (adjusted OR 1.08, 95% CI 0.83-1.41; p = 0.559). After adjustment for current age and sex, the comorbidity excess in LORA was no longer evident (adjusted rate ratio 0.79, 95% CI 0.70-0.89), while ESR remained modestly higher (adjusted ratio 1.17, 95% CI 1.02-1.33). Adding current age did not materially change the onset-group estimate (adjusted OR 1.05, 95% CI 0.76-1.44).Conclusion LORA and YORA showed similar disease activity, treatment patterns, and follow-up outcomes. The higher comorbidity burden in LORA was explained by chronological age, while ESR remained modestly elevated after age adjustment. Findings support treat-to-target principles regardless of age at onset, alongside management of comorbidities in older patients.
SN - 2296-858X
ER -