Dr. Majithia is associate professor, Department of Medicine, Division of Rheumatology, University of Mississippi School of Medicine, Jackson,
Mississippi
Dr. Peel is assistant professor, Department of Medicine, Division of Geriatrics, University of Mississippi School of Medicine, and
staff physician, GV (Sonny) Montgomery VA Medical Center, Jackson.
Dr. Geraci is professor, Department of Medicine, University of Mississippi School of Medicine, and chief, medical service, GV (Sonny)
Montgomery VA Medical Center.
Disclosure: The authors state that they have no conflict of interest or financial relationship to disclose. Abstract
Rheumatoid arthritis (RA) in the geriatric population presents a unique challenge to treating clinicians. It can present as
preexisting disease that may have been present for years or as a de novo onset of the illness. Diagnosis and management requires
a detailed knowledge of the disease, its differential diagnoses, and the therapeutic options. A number of other diseases can
mimic the illness and must be thoroughly evaluated to avoid serious consequences. New agents to treat RA are available that
have shown promise in clinical trials and practice. Aggressive RA treatment should not be withheld in the geriatric population
just because of advanced age, rather, treatment should be individualized, especially considering comorbidities and other factors
that can specifically affect a patient's quality of life. Coordination of care among geriatricians and rheumatologists is
the key to achieving optimal outcome.
Majithia V, Peel C, Geraci SA. Rheumatoid arthritis in elderly patients. Geriatrics. 2009;64(9):22-28.
Key words: rheumatoid arthritis, diagnosis, therapy, biologic therapeutic agents, anti-TNF therapy, prognosis
Drugs discussed: abatacept, adalimumab, anakinra, auranofin, azathioprine, bisphosphonates, certolizumab, cyclosporine, d-penicillamine,
etanercept, golimumab, hydroxychloroquine, intramuscular gold, infliximab, leflunomide, methotrexate, minocycline, prednisone,
rituximab, sulfasalazine, tocilizumab
Although joint complaints among geriatric patients are usually caused by degenerative, noninflammatory arthritis, various
forms of inflammatory arthritides are frequently present. Both forms of arthritis have a profound effect on functional status,
interfere with activities of daily living, reduce physical mobility, and may secondarily increase mortality. As the "baby-boomers"
age, the population's disability from arthritis, especially from inflammatory arthritis, continues to grow proportionately.
Clinical presentation
Table 1: Differences between EORA and YORA
|
Rheumatoid Arthritis (RA) is not an uncommon disease afflicting people above the age of 60 years. In the United States, it
is prevalent in approximately 2% of those 60 years old and older and is generally more prevalent among women, Mexican Americans,
people with less education, and among patients who are 70 years old and older.1 It is not clear whether elderly onset RA (EORA) is a distinct entity from young onset RA (YORA) [Table 1]1-6 Differences in demographic and clinical features might be at least partly related to the significant difficulty in establishing
the diagnosis in the elderly.2 A number of other rheumatic conditions, such as osteoarthritis (OA), gout, and arthritis associated with endocrine disorders,
have similar clinical, laboratory, and radiographic findings, and current diagnostic criteria cannot always differentiate
them from RA.3,4 Thus, diagnosis of RA in this population can be challenging, yet it is crucially important in light of the many effective
RA treatments now available.
There are 2 distinct clinical presentations of RA in older patients: EROA, or de novo disease in persons first diagnosed after
age 60, and persisting RA first diagnosed before age 60. Only subtle clinical differences exist between them.5,6 In EORA, there is slightly less female predominance and acute onset with marked elevation in inflammatory markers is more
common than in RA diagnosed at younger ages.5,7 This clinical presentation is highlighted by significant morning stiffness, with prominent involvement of the upper extremities
(especially shoulders) and marked inflammatory changes. Most of the remaining geriatric patients with RA have had disease
activity for several decades and demonstrate advanced sequelae of longstanding illness or its treatment.
E-mail Alerts
RSS Feeds
Practice Tools
