Rheumatoid Arthritis in Elderly People

Abstract

Rheumatoid arthritis (RA) is a chronic, systemic connective tissue disease, characterized by progressive, destructive polyarthritis with internal organs involvement due to active, systemic inflammation. The onset of disease occurs usually in 4th or 5th decade of life. Since the general population is ageing, beginning of RA in older age is more and more common. The term elderly onset of rheumatoid arthritis (EORA) describes the disease with onset at age over 60. Several observational studies indicated, that proportion of women and men is comparable in EORA. Clinical course of the disease is characterized by sudden onset with general constitutional symptoms, high disease activity and inflammatory parameters. Involvement of large joints is more common, specially shoulder joints. Antibodies typical for RA (rheumatoid factor, anti-citrullinated peptide) are usually negative. More advanced destructive changes of joints and functional impairment are also characteristic for EORA patients in comparison with younger onset of RA (YORA). In clinical practice the use of methotrexate and biological drugs is less common, and glucocorticosteroids more common in EORA. Due to high RA activity, patients with EORA should be treated in the same way as YORA, with careful monitoring due to higher risk of adverse events associated with treatment.

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“…The hypothesis of different pathogenesis for EORA is supported by the evidence of a diverse clinical picture, including higher recognition of overlapping manifestations with PMR and RS3PE [145,148]. Due to the high prevalence of patients with inflammatory involvement of shoulders, the differential diagnosis between EORA and PMR is quite challenging, and in these cases, the presence of anti-citrullinated protein/peptide antibodies (ACPA) is highly suggestive of RA [149].…”

“…Due to the high prevalence of patients with inflammatory involvement of shoulders, the differential diagnosis between EORA and PMR is quite challenging, and in these cases, the presence of anti-citrullinated protein/peptide antibodies (ACPA) is highly suggestive of RA [149]. Nonetheless, in patients with EORA, there is a lower prevalence of autoantibodies compared to young-onset rheumatoid arthritis (YORA) [148,150]. Although the presence of autoantibodies in RA is generally associated with a worse disease outcome, a higher frequency of acute disease onset especially in patients with EORA and negative RF has been observed [151].…”

“…In the past decades, different studies underlined the existence of clinical and serological differences between patients with EORA and those with YORA [145,148,151]. In contrast with YORA, which mainly occurs in women, in EORA, a balanced gender distribution has been reported, with evidence of a clinical course characterized by important systemic features, higher disease activity, and more pronounced inflammatory parameters [145,148,151]. Also, compared to YORA, EORA shows more common involvement of large joints 145, 148, 151], and a higher frequency of distalproximal involvement seems characteristic [150].…”

“…However, the presence of comorbidities in elderly RA patients is not a negligible aspect, and the occurrence of drug-related adverse events is quite frequent [159]. The prescription of GCs is a remarkable approach in clinical practice, and its use in EORA is more common than MTX and biologic drugs [148]. However, the role of GCs is still controversial, as their short-term symptomatic relief and potential medium-term effects on structural damage are counter-balanced by their side effects.…”

Systemic Inflammatory Parameters in Patients with Elderly-Onset Rheumatoid Arthritis (EORA) and Young-Onset Rheumatoid Arthritis (YORA)—An Observational Study

“…Rheumatoid arthritis (RA) is a chronic, autoimmune disease, characterized by progressive, symmetric polyarthritis, leading to irreversible destruction and deformities of the joints. The disease affects primarily women and is characterized by an average age onset of 55 years, with a peak incidence between 30 and 50 years of age [ 1 , 2 ].…”