[Elderly onset rheumatoid arthritis]

Area of Science:

• Rheumatology
• Geriatric Medicine
• Immunology

Context:

• Rheumatoid arthritis (RA) onset in individuals aged 60 and older (elderly-onset rheumatoid arthritis, EORA) exhibits distinct clinical and prognostic features compared to younger-onset RA (YORA).
• Understanding these differences is crucial for accurate diagnosis and tailored treatment strategies in the aging population.
• Existing literature highlights variations in presentation, disease activity, and long-term outcomes between EORA and YORA.

Purpose:

• To review and synthesize available data comparing the clinical presentation, disease activity, radiographic damage, and functional outcomes of EORA versus YORA.
• To elucidate the specific differences observed between seropositive and seronegative EORA patients.
• To provide a comprehensive overview of the current understanding of EORA and its unique characteristics.

Summary:

• EORA differs from YORA with a more balanced sex distribution, acute onset, frequent large joint involvement (especially shoulders), and higher initial disease activity.
• Longitudinal data indicate greater disease activity, more severe radiographic damage, and functional decline in seropositive EORA patients compared to YORA.
• Seronegative EORA patients show a milder disease course and better outcomes, often presenting with polymyalgia rheumatica or remitting seronegative symmetrical synovitis with pitting edema.

Impact:

• Highlights the importance of considering age at onset in RA patient stratification and management.
• Suggests potential differences in treatment response and long-term prognosis based on age and serological status.
• Informs clinical practice and future research directions for optimizing care in elderly RA patients.