Romao VC, Humby F, Kelly S, et al. - This study was undertaken to evaluate in a unique biopsy-driven, treatment-naïve early arthritis cohort, the relationship between synovial pathobiology of elderly- (EORA) and younger-onset rheumatoid arthritis (YORA) individuals through clinical, imaging and treatment response outcome-measures. Researchers included a total of 140 individuals with early RA (< 12months) starting before (YORA, n = 99) or after (EORA, n = 41) age 60 who had an ultrasound-guided synovial biopsy prior to conventional immunosuppressive therapy and after 6 months. They prospectively obtained clinical, ultrasound and radiographic data and compared between groups and against immunohistological features. Predictors of clinical response (disease activity score-28-erythrocyte sedimentation rate [DAS28-ESR]<3.2) were ascertained applying multivariate logistic regression at 6 months and radiographic progression (≥1-unit-increase in Sharp van der Heijde [SvdH] score) at 12 months. The results reveal that, in comparison with YORA, early EORA presents differently and has a worse overall prognosis, with poorer clinical, histological, ultrasonographic and radiographic outcomes.