Background
Controversy exists in delineating the characteristics and therapeutics involved in late-onset rheumatoid arthritis (LORA) and younger-onset rheumatoid arthritis (YORA). Many studies have suggested that the disease process of the LORA patient is distinctly different, and thus requires different treatment. Our preliminary work using a rigidly defined, rheumatoid factor (RF)-positive rheumatoid arthritis prospective cohort of 263 patients suggests that LORA and YORA patients are similar after correcting for age-related factors, for example erythrocyte sedimentation rate and C-reactive protein. In the same cohort of patients, Wu and colleagues recently demonstrated that the presence of both shared epitope-containing DRB1*04 alleles and novel RANKL polymorphisms was associated with an 18–20 year earlier onset of rheumatoid arthritis in YORA patients and did not predict increased severity of disease.