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[Other systemic diseases in the elderly].

Lê Thi Huong Du1, Bertrand Wechsler

  • 1Service de Médecine Interne, Groupe Hospitalier Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75651 Paris Cedex 13, France. du.boutin@psl.ap-hop-paris.fr

Annales De Medecine Interne
|December 18, 2002
PubMed
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Systemic diseases like Wegener's granulomatosis and Henoch-Schönlein purpura disproportionately affect the elderly. Advanced age is an independent predictor of poor prognosis and increased mortality in these conditions.

Area of Science:

  • Rheumatology
  • Geriatrics
  • Internal Medicine

Background:

  • Systemic diseases present differently in elderly patients.
  • Age significantly impacts disease prevalence, clinical manifestations, and prognosis.

Purpose of the Study:

  • To review the impact of aging on the presentation and outcomes of specific systemic vasculitides.
  • To highlight age-related differences in Wegener's granulomatosis, Henoch-Schönlein purpura, and polyarteritis nodosa.

Main Methods:

  • Literature review focusing on age-related changes in systemic vasculitides.
  • Analysis of clinical features, comorbidities, and mortality in elderly patients compared to younger cohorts.

Main Results:

  • Elderly patients with Wegener's granulomatosis show increased renal and CNS involvement, but less upper airway disease and hemoptysis.

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  • Henoch-Schönlein purpura in the elderly is associated with renal failure and neoplasia, potentially as a paraneoplastic syndrome.
  • Periarteritis nodosa in the elderly frequently involves viral B hepatitis and skin vasculitis, with temporal artery involvement possible.
  • Atheroembolic disease mimics systemic vasculitis, carrying a high mortality rate (>60% in symptomatic forms).
  • Aging is consistently identified as an independent predictor of poor prognosis across these conditions.

    • Conclusions:

    • Age is a critical factor influencing the clinical course and outcomes of systemic vasculitides.
    • Specific vasculitides manifest uniquely in the elderly, requiring tailored diagnostic and management approaches.
    • Early recognition and management are crucial for improving prognosis in elderly patients with systemic diseases.