EORA or YORA?: There is a difference. EORA means late... - NRAS

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EORA or YORA?

There is a difference. EORA means late onset of RA, after 65, YORA usually found between 30-60. There seems to be many different aspects of treatment and disease progression that should be considered and evaluated when choosing a therapy route.. On this forum I have not seen this distinction being made. It would be interesting to know what catagory forum members belong to. Having followed the forum for 2,5 years I have a feeling that most of us belong to the YORA group?

Here is one link to give more understanding on the differences.

ncbi.nlm.nih.gov/pmc/articl...

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Just read it Simba, a great read and I wouldn't have known until you mentioned it xxx

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Hi popsmith

Have all through my RA thought that there must be a difference and that it should be explored in every new case of RA and also that patients should be informed of the differences. This is the first time I stumbled upon research on this and was very glad since many of my questions concerning my own situation were answered. x.Simba

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Yes...Same here. It was really interesting. Thanks.

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I felt that paper raised more questions than it answered. So, YORA is < 45yo and EORA > 65yo. For example, where do the people between 45yo and 65yo fit? That’s a 20 year gap, that isn’t accounted for. Of course RA/IA is likely to be diagnosed at an older age, because it can be difficult to diagnose in the 45-65yo age group - there are people who are undiagnosed for many years.

I personally believe that JIA cases are very different to someone like myself (Diagnosed at 61yo) - because they are often very young people, who have a mountain to climb for a long period of time to feel OK, and my heart goes out to them.

Then there’s a bunch in between - like the 45 => 65yo who that paper don’t discuss - very difficult for those folk.

Then we have the > 60yo, like myself - equally difficult.

At the end of the day, I’m not a fan of trying to differentiate where someone lies on the “RA Spectrum” - it’s just totally a pain in the BS for everyone.

I don’t believe that paper contributed much in the way of new knowledge.

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Can imagine that the categories are overlapping but I don't understand quite what you mean. If YORA are those who are diagnosed between 30 and 60 and EORA fro 65 up. So that would only be a gap between 60 and 65. There are some studies that see the 60 and up infact belonging to EORA.

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Article defines EORA as >65 and doesn’t actually define YORA at all. They kind of link it by referring to younger onset RA as being between 25 - 45 in the Abstract. They fail to fully define it. So 46 => 64 are not defined at all.

Basically the paper discusses the benefits of full on treatment for EORA patients, which they state Is their interest.

Ultimately they decide that EORA patients benefit from the same aggressive treatment as YORA patients do.

Bit like “Nothing to see here, move on” :) cheers :)

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Here a clear definition. Above or below 60 onset.

ncbi.nlm.nih.gov/pubmed/403...

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To me the most interesting infact was that in EORA you do have more time to think about the treatment route and also be more sure about the individual situation, since erosive progression is not as aggressive as in YORA. There is no point in my view to start toxic meds before your diagnosis is clear. The study also showed that EORA patients were in fact treated less aggressively. The fact that they came to the conclusion that EORA should be just as aggressively treated as YORA was in my view more a statement of opinion that has no scientific proof.

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Quite funny really, I read another paper recently talking about EORA but it was early onset RA not elderly onset RA! Basically people who were too old for juvenile, but not yet in the main category of when it appears of 45+.

I think the thing that interests me most would be work on what is most suitable in treatment terms for the over 60s/65s, as metabolism changes so much.

(I did also notice that the proof reading had missed that NOAR is Norfolk database, not Norwark....but perhaps not as obvious to someone Turkish!

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Yes HH this is what has interests me all along, the metabolic changes and the effects on our immunesystem when we age. When I was diagnosed I was in the EORA catagory and really wanted to know more how age mattered when starting treatment. The well known professor that diagnosed me gave me no clue. The gold standard, aggressive medication from the start. Take it or leave it. He did not tell me that differential diagnoses in EORA is important to make since for example PMR can be mistaken for RA and that there infact are three different catagories that EORA can be divided into, and so on. Here another link that may interest you.

onlinelibrary.wiley.com/doi...

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This is interesting, thank you for sharing.

I didn’t know that general onset was 45 years plus. I’ve always felt not sure where I fit in. I was diagnosed at 21, so I was a young adult but did not really relate to the younger ones with juvenile arthritis but equally had problems that perhaps were more relatable to younger people like; issues at university.

I wonder if the older people who are diagnosed don’t get such aggressive treatment because some of their symptoms are assumed to be osteoarthritis or perhaps a normal part of aging. Just a theory and certainly not one I agree with, of course.

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Yes Trashdoll, getting RA diagnosis at 21 puts you sort of in a special place since 30+ are seen as YORAs. Are you then treated as juvenile arthritis patient or what?

If believing the results of studies it does seem that usually erosive progression in EORA is not so severe as often in YORA also as you say, most people in their late 60 ees and 70 ees do have OA and there are more possibilities that can be mixed with RA. An other illness in this age group is PMR , that can have a very similar presentation in the beginning as RA. Also existing dysfunctions and dieses must be assessed before starting any aggressive medication, and in EORA usually more. In EORA there also seems to be 25% where RA runs it's course in18 months without immunosupressants. xxSimba

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Sorry!! Did mean Crashdoll😐

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Hmm. interesting paper, but it seems the manifestations and course of the disease are different for different people, regardless of age, if you look at posts on this site overall.. More research required I guess.

I was interested in a previous post of yours citing a little experiment done on the use of coffee for Mtx side effects (presumably fatigue. ) I would be interested to know if anyone rates it.

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In the coffee Mtx study it was not just fatigue but moderate and severe mtx intolerance that was " cured" in 55% and the med did not need to be discontinued.

ncbi.nlm.nih.gov/pubmed/275...

Those with bad side effects could really try if coffee makes a difference.

There are in fact numerous studies on in what respects RA differs when onset before or after 60 ( crudley).

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Hmmm what about us in our 20s? Too old for JIA, At the moment I have no patience for my RA my finger joints are swollen & sting as heck & im meant to be typing all day. It’s pain we would rather not have at the end of the day!

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Hi, I was diagnosed after 65, but had had two foot reconstructions in my 50s, and now Rhumy thinks that was the start of RA, so not really sure.

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Hello Lyneal, I think maybe the reason for the reconstruction is quite telling. Also major operations and accidents may trigger RA after some years. The typical EORA seems to start quite suddenly and aggressively with higher inflammation markers than YORA. Going back looking at ones symptom history does give a lot of clues about the risk of developing RA.

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Hi Need2knowN,

I can well emphasize with your frustration! RA should really leave the young alone. I am sure you have tried different ways to decrease inflammation but one thing that seemes to benefit the young best are dietary modifications especially leaving out gluten and dairy and secondly checking estrogen/ progesterone ratio. If estrogen too high, this feeds the inflammatory enviroment. Low thyroid is another thing to check, since it does give very similar joint symptoms. I wish you all the luck in finding a way to calm your RA. xSimba

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Thank you! I’ve just commenced a Low carb diet which accidentally is grain /gluten free! So we’ll see!

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Thumbs up!👍🏻👍🏻

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Thanks for posting Simba, I’ve not had a chance to look at the link yet but I was 23 when diagnosed x

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