Late-onset rheumatoid arthritis: clinical features, diagnostic challenges, and treatment approaches

Late-Onset Rheumatoid Arthritis (LORA) is receiving increased clinical attention due to global aging trends. LORA presents distinct diagnostic, clinical, and therapeutic challenges. It often presents with a balanced gender distribution, acute onset, preferential involvement of larger joints, and decreased seropositivity. The diagnostic process is complex due to atypical presentations, comorbidities, and limitations of classification criteria, which insufficiently address the heterogeneity of LORA phenotypes. Patients with LORA often experience age-related geriatric syndromes, including frailty, cognitive decline, and malnutrition, in addition to comorbid cardiovascular disorders, pulmonary involvement, oncologic conditions, and osteoporosis. All these factors confound disease progression and treatment strategies, necessitating careful consideration of polypharmacy and modified drug metabolism. While the treatment principles largely align with those of Younge-Onset Rheumatoid Arthiritis (YORA), LORA management requires individualized approaches. Available evidence suggests that with proper monitoring, disease-modifying anti-rheumatic drugs (DMARDs) are safe and effective for older adults. Glucocorticoids should be minimized due to potential detrimental effects. Despite elevated baseline disease activity and functional deterioration, effectively managed LORA patients may achieve disease control similar to that of younger individuals. This review advocates for age-adjusted diagnostic strategies and patient-centered care models tailored to the needs of older RA patients. Addressing these unmet needs may enhance outcomes and quality of life for the growing population of LORA patients.