Journal article
Serious infection risk in older adults with RA receiving biologic or targeted synthetic DMARDs: the role of age at disease onset
Therapeutic advances in musculoskeletal disease, Vol.18, pp.1-13
2026
DOI: 10.1177/1759720X261433254
PMCID: PMC13018702
PMID: 41907684
Abstract
Does the age at which rheumatoid arthritis begins affect the risk of serious infection in older adults treated with biologic medications? Older adults with rheumatoid arthritis (RA) are known to have a higher risk of serious infections when treated with biologic or targeted synthetic medications. However, it is unclear whether this risk is influenced by the age at which RA first develops. Some people develop RA later in life, while others are diagnosed earlier but continue treatment into older age. In this study, we examined adults aged 60 years and older with RA who started biologic or targeted therapies. We compared people whose RA began at age 60 or later (late-onset RA) with those who were diagnosed earlier in life (young-onset RA). We evaluated the risk of serious infections, defined as infections requiring hospitalization, intravenous antibiotics, or resulting in death. We found that the risk of serious infection did not differ meaningfully based on whether RA began earlier or later in life, both among patients starting anti-TNF therapies and among those starting other biologic or targeted treatments after prior anti-TNF use. Instead, infection risk was more strongly related to other factors, including older age, a prior history of serious infection, worse physical function, and recent long-term use of glucocorticoids (steroids). These findings suggest that, in older adults with RA, infection risk is influenced less by the age at which RA began and more by functional status and treatment-related factors. Efforts to reduce long-term steroid use, optimize disease-modifying therapy, and support physical function may be important strategies to lower infection risk in this population.
Details
- Title: Subtitle
- Serious infection risk in older adults with RA receiving biologic or targeted synthetic DMARDs: the role of age at disease onset
- Creators
- Jiha Lee - University of MichiganSofia Pedro - The National Databank for Rheumatic DiseasesSara H. Bares - University of Nebraska Medical CenterGulsen Ozen - University of IowaTed R. Mikuls - University of Nebraska Medical CenterKaleb Michaud - The National Databank for Rheumatic Diseases
- Resource Type
- Journal article
- Publication Details
- Therapeutic advances in musculoskeletal disease, Vol.18, pp.1-13
- DOI
- 10.1177/1759720X261433254
- PMID
- 41907684
- PMCID
- PMC13018702
- NLM abbreviation
- Ther Adv Musculoskelet Dis
- ISSN
- 1759-720X
- eISSN
- 1759-7218
- Publisher
- SAGE Publications
- Grant note
- Department: US Department of Defense u.s. department of veterans affairs: I01-BX003635 National Institute of General Medical Sciences: U54GM115458 National Institute on Aging: K23AG082727
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: JL is supported by the National Institutes of Health, National Institute on Aging (K23AG082727). TRM receives research support from the National Institutes of Health, National Institute of General Medical Sciences (U54GM115458), the U.S. Department of Veterans Affairs (I01-BX003635), and the U.S. Department of Defense (PR200793).
- Language
- English
- Date published
- 2026
- Academic Unit
- Internal Medicine
- Record Identifier
- 9985149413302771
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