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Elderly-onset rheumatoid arthritis

D van Schaardenburg1, F C Breedveld

  • 1Department of Rheumatology, University Hospital, Leiden, The Netherlands.

Seminars in Arthritis and Rheumatism
|June 1, 1994
PubMed
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Elderly-onset rheumatoid arthritis (EORA) presents differently than younger-onset RA, with higher disease activity and functional decline in seropositive cases. Caution is advised with certain medications in older adults.

Area of Science:

  • Rheumatology
  • Geriatric Medicine
  • Immunology

Background:

  • Elderly-onset rheumatoid arthritis (EORA) is defined as rheumatoid arthritis (RA) with onset at age 60 years or older.
  • EORA exhibits distinct clinical features compared to younger-onset RA (YORA), including a more balanced gender distribution and a higher incidence of acute onset with systemic symptoms.
  • Shoulder involvement and disease activity are frequently elevated in EORA patients.

Purpose of the Study:

  • To delineate the specific characteristics and differences between EORA and YORA.
  • To investigate the impact of EORA on disease progression, radiographic damage, and functional decline.
  • To explore potential pathogenetic variations, particularly in seronegative EORA.

Main Methods:

  • Comparative analysis of clinical presentation and longitudinal outcomes between EORA and YORA cohorts.

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  • Investigation of serological status (seropositive vs. seronegative) and its correlation with clinical manifestations and genetic associations (e.g., HLA-DR4).
  • Differential diagnosis considerations including polymyalgia rheumatica, remitting seronegative symmetrical synovitis with pitting edema, crystal-induced arthritis, and inflammatory osteoarthritis.

    • Main Results:

    • Longitudinal studies indicate greater disease activity, radiographic damage, and functional decline in EORA compared to YORA, specifically in seropositive patients.
    • Seropositive EORA is associated with HLA-DR4, whereas seronegative EORA shows potential heterogeneity and overlap with other rheumatologic syndromes.
    • Efficacy and toxicity of second-line drugs are comparable between age groups, but NSAIDs and prednisone require careful use in the elderly.

    Conclusions:

    • EORA represents a distinct clinical entity from YORA, particularly in seropositive individuals, with a more aggressive disease course.
    • Seronegative EORA may encompass heterogeneous pathogenetic mechanisms, requiring careful differential diagnosis.
    • Management strategies for EORA should consider age-related factors and potential drug toxicities, especially concerning NSAIDs and corticosteroids.