Diagnosis and management of rheumatic diseases in older patients

The young and the old move differently, yet there are standards of normality for each. Chronic diseases of the joints, with their concomitant stiffness and pain, cause more fear of an impending crippling disability and loss of life space and content than actual pain and stiffness. Thus, a prime goal of physicians who treat patients who have chronic musculoskeletal diseases is to allay this fear by correcting misconceptions about arthritic diseases. Drug therapy can relieve the pain and stiffness and control the inflammation that causes these symptoms. Important aspects of rheumatoid arthritis, osteoarthritis, and polymyalgia rheumatica, a closely related disorder, are emphasized to point out the difficulty of the differential diagnosis of these diseases in older patients and the need for realistic therapeutic goals. A combination-drug regimen, with a nonsteroidal anti-inflammatory drug for alleviation of pain and control of inflammation and an analgesic drug for relief of residual pain, is the drug therapy of choice within the context of a total management program. By addressing both the physiologic and the psychologic aspects of musculoskeletal disease, physicians can help patients lead more active and useful lives.