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Management Issues with Elderly-Onset Rheumatoid Arthritis

An Update

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Abstract

Elderly-onset rheumatoid arthritis (EORA) is defined as rheumatoid arthritis (RA) starting at >60 years of age. EORA is characterised by a lower female/male ratio compared with RA in younger patients and it more frequently has an acute onset accompanied by constitutional symptoms. Two incompletely overlapping subsets of RA have been recognised: one exhibits the classical RA clinical picture while the other has a polymyalgia rheumatica-like appearance, characterised by shoulder involvement, absence of rheumatoid factor and, usually, by a nonerosive course. Identification of anti-cyclic citrullinated peptide antibodies is useful for distinguishing the latter subset from true polymyalgia rheumatica. Elderly-onset spondyloarthritis, crystal-related arthritis, remitting seronegative symmetrical synovitis with pitting oedema syndrome and hepatitis C virus-related arthritis must also be considered in the differential diagnosis. EORA treatment requires prudence because of the increase in age-related risks pertaining principally to the renal, cardiovascular and gastrointestinal systems. No groups of molecules usually employed for RA therapy in younger subjects (analgesics, NSAIDs, corticosteroids, disease-modifying antirheumatic drugs, anticytokine drugs) can be excluded a priori from the treatment of EORA patients. Nevertheless, the risk/benefit ratio relating to their use must be accurately evaluated for every single patient. Recently marketed compounds such as leflunomide and tumour necrosis factor-α antagonists have also increased the therapeutic opportunities for aged RA patients.

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Acknowledgements

This work was supported by a grant from the Government of Basilicata (Lucania) Region.

The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Rheumatology Department of Lucania, Matera and Potenza: S. Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, and the Rheumatology Division of the ‘Villa Pini’ Clinic, Chieti, Italy

    Ignazio Olivieri, Carlo Palazzi, Giovanni Peruz & Angela Padula

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  1. Ignazio Olivieri
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  2. Carlo Palazzi
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  3. Giovanni Peruz
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  4. Angela Padula
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Correspondence to Ignazio Olivieri.

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Olivieri, I., Palazzi, C., Peruz, G. et al. Management Issues with Elderly-Onset Rheumatoid Arthritis. Drugs Aging 22, 809–822 (2005). https://doi.org/10.2165/00002512-200522100-00002

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