[Polyarthritis in the elderly]

Ten to thirty-three per cent of all cases of rheumatoid arthritis (RA) develop after sixty years of age. Late-onset RA patients are more likely to be male, to have faster onset of symptoms, to experience shoulder and hip disease initially, and to have higher erythrocyte sedimentation rates; they are less likely to develop rheumatoid nodules, extraarticular manifestations, positive serologic tests, or unfavorable outcomes. There are roughly three patterns of late-onset RA: a classical form which resembles typical adult-onset RA; a limited, fairly mild form in which Gougerot-Sjögren syndrome often coexists; and a form in which the shoulders and hips are involved first. The latter form, whose early stage closely resembles polymyalgia rheumatica (PMR), accounts for approximately 25% of cases, is very specific of elderly patients, and is difficult to differentiate from PMR. RS3PE (Remitting Seronegative Symmetrical Synovitis with Pitting Edema) is a different entity from RA.