[Onset of rheumatoid arthritis in the elderly]

The predominant age of manifestation of rheumatoid arthritis (chronic polyarthritis) is between the 35th and 45th year of life. Onset of disease in the higher age groups is, however, not infrequent. Comparison of two groups of patients with rheumatoid arthritis with disease onset before or after the age of 60 showed that a quarter of late-onset cases commence particularly acutely. These was a remarkably early involvement of shoulder joints with a frequency of up to 50%. The symptom triad of shoulder joint involvement, markedly raised ESR and severe generalised disease was characteristic. This combination of symptoms is not infrequently attributed erroneously to the "shoulder-arm syndrome or suspect malignant tumour". Differential diagnosis from rheumatic polymyalgia or true paraneoplastic arthropathy may be difficult. Therapeutic problems arise mainly due to the high number of other medical problems of the elderly.