Rheumatic Disease in the Elderly: Rheumatoid Arthritis

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This article summarizes the different aspects of rheumatoid arthritis and the spectrum of diseases that can present as rheumatoid arthritis in the elderly population. With the ageing of the western population, different forms of inflammatory arthritis' prevalence and incidence are increasing in elderly persons. Difficulties in establishing the diagnosis and introducing new treatment modalities in this patient group pose a great challenge for clinicians. The management of inflammatory arthritis in the elderly requires special consideration in regard to the comorbidities and increased frequency of adverse events. There is substantial need for improving aspects of diagnostic and therapeutic interventions that will reduce the impact of inflammatory arthritis in the growing elderly population.

Section snippets

Rheumatoid arthritis

Rheumatoid arthritis (RA) is now known to increase in incidence and prevalence up to approximately age 85. The prevalence of RA in persons 60 years of age and older is reported to be approximately 2% [1]. The issue of whether RA arising in the elderly population is a distinct disease from younger onset RA (YORA) is not settled. Differences in demographic and disease features such as sex, type of onset, involvement of large versus small joints, disease activity, and the rate of progression and

Polymyalgia rheumatica

PMR may be an overlapping syndrome with seronegative EORA [3]. Although the diagnosis of PMR frequently is straightforward, it can be elusive. Elderly patients may have musculoskeletal complaints related to underlying degenerative disease, neurologic syndromes, or other causes that can obscure the diagnostic picture. Patients who have PMR are classically older than 50 years of age (90% are older than 60), and most are white [48]. It is a syndrome characterized by pain and morning stiffness in

Summary

In old age, physiologic deterioration complicates the presentation of pathologic processes and handling of therapeutic substances. Despite developments in science and technology, controversies in understanding and managing arthritis in the elderly still exist. The impact of musculoskeletal problems on the function and lifestyle of elderly should stimulate clinicians to focus on improving diagnostic and therapeutic interventions that will minimize the sequela of RA in the geriatric population.

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  • A version of this article originally appeared in the 21:3 issue of Clinics in Geriatric Medicine.

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