{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:44:36Z","timestamp":1777877076092,"version":"3.51.4"},"reference-count":38,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["U54GM115458"],"award-info":[{"award-number":["U54GM115458"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"u.s. department of veterans affairs","doi-asserted-by":"publisher","award":["I01-BX003635"],"award-info":[{"award-number":["I01-BX003635"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K23AG082727"],"award-info":[{"award-number":["K23AG082727"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000005","name":"Department","doi-asserted-by":"publisher","award":["US Department of Defense"],"award-info":[{"award-number":["US Department of Defense"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Musculoskeletal"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Older age is a risk factor for serious infection (SI) associated with biologic or targeted synthetic DMARDs (b\/tsDMARDs) use in rheumatoid arthritis (RA). Among older adults with RA, one-third are diagnosed at \u2a7e60\u2009years (late-onset RA, LORA), while others are diagnosed earlier (young-onset RA, YORA). LORA is characterized by a more acute onset and heightened inflammatory burden due to age-related immune dysregulation. Whether RA onset age independently affects infection risk with b\/tsDMARDs remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Evaluate SI risk in older adults with RA initiating b\/tsDMARDs, stratified by RA onset age: LORA versus YORA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective cohort study using prospectively collected registry data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>From FORWARD, the National Databank for Rheumatic Diseases (2001\u20132019), we identified RA patients aged \u2a7e60\u2009years who initiated (1) anti\u2013TNF then (2) subsequent non-TNF b\/tsDMARDs. Patients were categorized as LORA versus YORA and matched using kernel-based propensity scores. SI was defined as an infection requiring hospitalization, intravenous antibiotics, or death. Multivariable Cox models estimated the risk of SI in LORA versus YORA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among 1379 LORA and 2727 weighted YORA patients initiating anti-TNF therapy, the crude incidence of SI was 28.2 and 20.5\u2009per 1000\u2009person-years. In adjusted models, LORA was not associated with increased anti-TNF-related SI risk compared to YORA (HR 0.82, 95% CI 0.63\u20131.02). Among 198 LORA and 675 weighted YORA patients subsequently initiating non-TNF b\/tsDMARDs, the crude incidence of SI was 17.3 versus 19.5\u2009per 1000\u2009person-years. In adjusted models, LORA was not associated with increased non-TNF related SI risk (aHR 0.81, 95% CI 0.31\u20132.12). Across cohorts, older age was independently associated with increased SI risk. For anti-TNF, prior SI and recent long-term glucocorticoid use, and for non-TNF, HAQ disability were also associated with SI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Age at RA onset was not independently associated with SI risk following b\/tsDMARD initiation. Risk stratification should prioritize functional status and treatment history.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1759720x261433254","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T11:34:06Z","timestamp":1774438446000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Serious infection risk in older adults with RA receiving biologic or targeted synthetic DMARDs: the role of age at disease onset"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6402-6563","authenticated-orcid":false,"given":"Jiha","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, University of Michigan, 300 North Ingalls Building, Room 7C27, Ann Arbor, MI 48109-5422, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8262-0956","authenticated-orcid":false,"given":"Sofia","family":"Pedro","sequence":"additional","affiliation":[{"name":"The National Databank for Rheumatic Diseases, Wichita, KS, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara H.","family":"Bares","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gulsen","family":"Ozen","sequence":"additional","affiliation":[{"name":"Division of Immunology and Rheumatology, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0897-2272","authenticated-orcid":false,"given":"Ted R.","family":"Mikuls","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA"},{"name":"The National Databank for Rheumatic Diseases, Wichita, KS, USA"},{"name":"VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5350-3934","authenticated-orcid":false,"given":"Kaleb","family":"Michaud","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA"},{"name":"The National Databank for Rheumatic Diseases, Wichita, KS, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)00457-9"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/0049-0172(94)90087-6"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-015-3031-x"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/1756-185X.13428"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/mr\/roae011"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr2.11625"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2005.051144"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/ar4540"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.55563\/clinexprheumatol\/ftfgmf"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.22688"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-020-04660-y"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.201135"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61704-9"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr2.11064"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr.24596"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2018.10.017"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204011"},{"key":"e_1_3_4_19_2","article-title":"The National Data Bank for Rheumatic Diseases (NDB)","volume":"34","author":"Michaud K.","year":"2016","unstructured":"Michaud K. The National Data Bank for Rheumatic Diseases (NDB). Clin Exper Rheumatol 2016; 34: S100\u2013S101.","journal-title":"Clin Exper Rheumatol"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-8-200710160-00010"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr2.70058"},{"issue":"6","key":"e_1_3_4_22_2","volume":"7","author":"Lee J","year":"2025","unstructured":"Lee J, Makris UE. ReplyACR Open Rheumatol 2025; 7(6): e70084.","journal-title":"ReplyACR Open Rheumatol"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22456"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr.25116"},{"issue":"12","key":"e_1_3_4_25_2","first-page":"2410","article-title":"A composite disease activity scale for clinical practice, observational studies, and clinical trials: the patient activity scale (PAS\/PAS-II)","volume":"32","author":"Wolfe F","year":"2005","unstructured":"Wolfe F, Michaud K, Pincus T. A composite disease activity scale for clinical practice, observational studies, and clinical trials: the patient activity scale (PAS\/PAS-II). J Rheumatol 2005; 32(12): 2410\u20132415.","journal-title":"J Rheumatol"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.7326\/M20-1594"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr2.70013"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12182"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2020.102528"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11357-024-01364-0"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.43105"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kead083"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2011-200702"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr2.11503"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr2.11584"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-212825"},{"key":"e_1_3_4_37_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keaa557"},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr2.11051"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr.25282"}],"container-title":["Therapeutic Advances in Musculoskeletal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1759720X261433254","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1759720X261433254","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1759720X261433254","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T22:40:38Z","timestamp":1777588838000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1759720X261433254"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":38,"alternative-id":["10.1177\/1759720X261433254"],"URL":"https:\/\/doi.org\/10.1177\/1759720x261433254","relation":{},"ISSN":["1759-720X","1759-7218"],"issn-type":[{"value":"1759-720X","type":"print"},{"value":"1759-7218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"article-number":"1759720X261433254"}}