AGE OF DISEASE ONSET AND RISK OF SERIOUS INFECTION WITH ANTI-TNF USE IN OLDER ADULTS WITH RHEUMATOID ARTHRITIS

Q: How were late-onset RA (LORA) and young-onset RA (YORA) defined in the study?

Patients were categorized by age at RA diagnosis: LORA was diagnosed at age ≥60, while YORA was diagnosed at age <60.

Q: What counted as a serious infection (SI) in this analysis?

SI required hospitalization, IV antibiotics, or death, and was linked to anti-TNF exposure within three months after treatment cessation.

Q: Did anti-TNF–associated SI risk differ between LORA and YORA?

No. Despite a higher crude SI incidence in LORA, adjusted analyses showed no significant difference in SI risk between LORA and YORA.

Q: Which factors were identified as independent risk factors for increased SI risk?

Long-term glucocorticoid use and older age were independent risk factors associated with higher SI risk.

Sep 29, 2026

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Older adults with rheumatoid arthritis (RA) face increased risk of serious infections (SI) when treated with biologics such as anti-TNFs. One-third of patients are diagnosed between ages 60–65, termed late-onset RA (LORA), which is associated with more acute symptoms and faster progression than young-onset RA (YORA). Using FORWARD data (2001–2019), patients initiating anti-TNF therapy were propensity-matched by age-at-diagnosis category and followed for SI events requiring hospitalization, IV antibiotics, or resulting in death. SI incidence was higher in LORA (3.6 vs 2.7 per 1000 patient-years), yet overall SI risk did not differ significantly after adjustment; long-term glucocorticoid use and older age increased SI risk.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages1

Reading Time3 min

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Abstract

Study design and population

Definitions and outcomes

Key findings and clinical implications

708 Innovation in Aging, 2025, Vol. 9, No. S2 SESSION 7120 (POSTER) MUSCULOSKELETAL HEALTH Abstract citation ID: igaf122.2413 AGE OF DISEASE ONSET AND RISK OF SERIOUS INFECTION WITH ANTI-TNF USE IN OLDER ADULTS WITH RHEUMATOID ARTHRITIS Jiha Lee1, Sofia Pedro2, and Kaleb Michaud3, 1. University of Michigan, Ann Arbor, Michigan, United States, 2. National Data Bank for Rheumatic Diseases, Wichita, Kansas, United States, 3. University of Nebraska Medical Center, Omaha, Nebraska, United States Older age increases the risk of serious infections (SI) in rheumatoid arthritis (RA) patients using biologics like anti-TNFs. About one-third of older adults are diagnosed with RA between ages 60-65, classified as late-onset RA (LORA) . LORA exhibits more acute symptoms and faster disease progression compared to young-onset RA (YORA), possibly due to age-related immune changes. This study utilized data from the FORWARD-The National Databank for Rheumatic Diseases (2001-2019) to assess SI risk differences in older adults with LORA versus YORA starting anti-TNF therapy. Patients aged ≥60 years, categorized by age at RA diagnosis (LORA ≥60; YORA < 60), were propensity-matched for demographics and health factors. Exclusions applied to those with other rheumatic diseases, cancer, or HIV preceding SI. SI was defined as infections requiring hospitalization, IV antibiotics, or causing death, linked to anti-TNF within three months after treatment cessation. The study included 1,219 LORA and 6,030 weighted YORA patients. LORA patients had fewer previous infections, lower glucocorticoid (GC) use, but higher methotrexate use. Although LORA had a higher crude SI incidence (3.6/1000 patient-years) than YORA (2.7/1000 patient-years), SI risk did not significantly differ (aHR 0.85, 95% CI 0.58-1.25). Adjusting for prior SI, smoking, and methotrexate use did not alter outcomes. Long-term GC use and older age were independent risk factors for increased SI risk. These findings indicate that SI risk from anti-TNFs does not vary by RA onset age but highlight the risky and often suboptimal reliance on long-term GC use in LORA patients, suggesting a need for improved treatment strategies.

FAQs

How were late-onset RA (LORA) and young-onset RA (YORA) defined in the study?

Patients were categorized by age at RA diagnosis: LORA was diagnosed at age ≥60, while YORA was diagnosed at age <60.

What counted as a serious infection (SI) in this analysis?

SI required hospitalization, IV antibiotics, or death, and was linked to anti-TNF exposure within three months after treatment cessation.

Did anti-TNF–associated SI risk differ between LORA and YORA?

No. Despite a higher crude SI incidence in LORA, adjusted analyses showed no significant difference in SI risk between LORA and YORA.

Which factors were identified as independent risk factors for increased SI risk?

Long-term glucocorticoid use and older age were independent risk factors associated with higher SI risk.

Sep 29, 2026

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