Rheumatoid Arthritis Age of Onset

Rheumatoid arthritis (RA) is a progressive, autoimmune disease that affects several joints in the body. The disease is caused by the immune system attacking itself, targeting tissue primarily around joints.

RA is the most common form of inflammatory arthritis, with the first symptoms most commonly being joint stiffness and swelling of the hands, feet, knees, or wrists. Women are three times more likely to develop RA, and across all demographics, it can start as early as 30 years old.

Why Age of RA Onset Matters

The age of onset of rheumatoid arthritis matters for several reasons. Depending on the age of onset, the severity, progression, and treatment options for RA may look different.

Studies have shown late-onset rheumatoid arthritis (LORA), also referred to as elderly-onset RA, is associated with greater disease activity, reduced function at baseline, and more radiological damage. On the other hand, young-onset RA (YORA) results in a long road with the disease and presents in a different way physically and in blood testing.

Overall, it's important to get diagnosed and treated early if possible, given the progressive, systemic nature of RA.

Average Onset

Most people have symptoms of RA between ages 30 and 60, but men are unlikely to be diagnosed under age 45. Across both men and women, the median age of onset is 58.

RA can be categorized as young-onset rheumatoid arthritis (YORA) and later-onset rheumatoid arthritis (LORA). The basic symptoms and possible treatments are the same at any age, but a few things set these two RA types apart.

Young-Onset RA

YORA are typically considered in people between ages 16 and 40. People with type of RA tend to present with specific physical symptoms and positive lab testing. While uncommon, some young adults do get diagnosed with RA. In fact, eight in every 100,000 people between the ages of 18 and 34 are found to have RA.

As far as physical symptoms go, it has been documented that young-onset RA has a tendency to be more severe. Their symptoms often include small joint involvement like the hands and feet, instead of large-joint involvement of shoulders.

The start of the disease is usually stiffness and swelling in these joints. It will come on gradually and progress over time instead of an acute, or sudden, onset.

Young-onset RA shows up in blood work more often, which is a signal the disease can be more severe and progress quicker. While this is true, it should be noted that when healthcare providers analyze blood tests, they will look at the whole picture and a positive test doesn't necessarily mean the person has RA.

Unfortunately, there is no cure for RA. For those diagnosed with RA at a young age, it's crucial to get treatment immediately, due to progression, severity, and likelihood of joint deformity and damage with time. Treatment options abound. With the goal of remission, studies show medications known as disease-modifying antirheumatic drugs (DMARDs) yield the best results.

Medications

Disease-modifying antirheumatic drugs (DMARDs) are a class of drugs used to treat inflammation. DMARDs slow the progression of RA and are more often used in YORA and not LORA. These include the medications methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine.

The American College of Rheumatology (ACR) recommends methotrexate as the first-line treatment for moderate to highly active RA.

Along with these drugs, non-steroidal anti-inflammatory medications (NSAIDs) may also be used to decrease inflammation and pain, including over-the-counter medications like Advil and Aleve.

Glucocorticoids (corticosteroids, or steroids) are also a possible treatment option, but are typically used for acute onset to relieve symptoms, with the goal to get off of these medications.

Therapy

Physical and occupational therapies are treatments used to keep the body strong and help people with RA continue with daily tasks independently. These therapies may be more often used in the elderly since they are less able to overcome ailments and have less strength than people with young-onset RA.

Surgery

If RA has done enough damage, surgery may be a possible treatment option. Surgery would be done to remove inflammation, repair tendons, fuse joints, or replace joints. Age may disqualify a patient from joint replacement if they are too young, however.

Given the length of the disease, early-onset patients may need surgery in the future after years of damage if medications are unable to control the disease.

Is Juvenile Arthritis Young-Onset RA?

Juvenile Arthritis (JIA) is the most common type of arthritis in children under 16. It used to be called juvenile rheumatoid arthritis. While RA and JIA are similar and both have symptoms of swelling and pain, they differ in prognosis. RA is a progressive, chronic condition while JIA is usually outgrown. Therefore, JIA doesn't fall into the group of young-onset RA patients.

Late-Onset RA

Late-onset RA, also referred to as elderly-onset RA, typically affects people over 60 years old. There are a few things that differentiate LORA from EORA.

In terms of physical presentation, late-onset patients usually have an acute onset. This means, Instead of symptoms showing up over time, the symptoms can come on quickly. Additionally, their disease will affect large joints like shoulders instead of small joints like hands or feet in EORA. With that said, it is common for late-onset RA to be less severe.

Additionally, people with LORA are more likely to experience systemic symptoms, including fever, myalgia, and weight loss.

Blood testing will also look different in LORA. Often the blood testing for antibodies and proteins in the blood will come back negative in people with late-onset RA.

People with elderly-onset RA also have more comorbidities. All stages of RA have a high rate of comorbidities, but elderly RA patients are more likely to have higher comorbidities related to old age.

Treatment for LORA is similar to that for early-onset RA, with an emphasis on steroid medications to address acute symptoms that are more common for late-onset patients.

Medications

Medication options for this group of RA patients include DMARDs, NSAIDs, and steroids. 

Given the acute onset common in LORA, steroids are sometimes used briefly to decrease pain and inflammation. However, ACR guidelines suggest avoiding steroids as much as possible and strongly recommend against long-term use.

NSAIDs can be used for pain control, but high-dose and/or chronic use carries multiple risks, including gastritis/peptic ulcer disease, kidney damage, and cardiovascular complications. 

Therapy

Physical and occupational therapies are used in patients with RA. Elderly-onset RA patients will experience severe symptoms from RA at a lower rate, but may still benefit from therapy to better manage everyday life and tasks.

Surgery

Joint replacement surgery is common among adults over 60 years old. While the quality of life of an elderly person may be greatly improved after surgery for RA, it is important to weigh the risks and consider the rehabilitation and care needed after the operation.

A Word From Verywell

Rheumatoid arthritis is a significant and life-altering diagnosis no matter the age of onset. Early diagnosis and treatment have been proven to improve outcomes and severity of the disease. Your healthcare provider will determine the best treatment for you based on age of onset, comorbidities, and severity. While treatment and follow-up appointments will be required to manage RA, it is possible to live a long and happy life with the disease.

Correction - January 23, 2023: This article was updated to clarify that rheumatoid arthritis is the most common form of inflammatory arthritis. Among all types of arthritis, osteoarthritis is the most prevalent.