Drugs & Aging

, Volume 22, Issue 10, pp 809–822

Management Issues with Elderly-Onset Rheumatoid Arthritis

An Update
  • Ignazio Olivieri
  • Carlo Palazzi
  • Giovanni Peruz
  • Angela Padula
Leading Article

DOI: 10.2165/00002512-200522100-00002

Cite this article as:
Olivieri, I., Palazzi, C., Peruz, G. et al. Drugs Aging (2005) 22: 809. doi:10.2165/00002512-200522100-00002
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Abstract

Elderly-onset rheumatoid arthritis (EORA) is defined as rheumatoid arthritis (RA) starting at >60 years of age. EORA is characterised by a lower female/male ratio compared with RA in younger patients and it more frequently has an acute onset accompanied by constitutional symptoms. Two incompletely overlapping subsets of RA have been recognised: one exhibits the classical RA clinical picture while the other has a polymyalgia rheumatica-like appearance, characterised by shoulder involvement, absence of rheumatoid factor and, usually, by a nonerosive course. Identification of anti-cyclic citrullinated peptide antibodies is useful for distinguishing the latter subset from true polymyalgia rheumatica. Elderly-onset spondyloarthritis, crystal-related arthritis, remitting seronegative symmetrical synovitis with pitting oedema syndrome and hepatitis C virus-related arthritis must also be considered in the differential diagnosis. EORA treatment requires prudence because of the increase in age-related risks pertaining principally to the renal, cardiovascular and gastrointestinal systems. No groups of molecules usually employed for RA therapy in younger subjects (analgesics, NSAIDs, corticosteroids, disease-modifying antirheumatic drugs, anticytokine drugs) can be excluded a priori from the treatment of EORA patients. Nevertheless, the risk/benefit ratio relating to their use must be accurately evaluated for every single patient. Recently marketed compounds such as leflunomide and tumour necrosis factor-α antagonists have also increased the therapeutic opportunities for aged RA patients.

Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  • Ignazio Olivieri
    • 1
  • Carlo Palazzi
    • 1
  • Giovanni Peruz
    • 1
  • Angela Padula
    • 1
  1. 1.Rheumatology Department of LucaniaMatera and Potenza: S. Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, and the Rheumatology Division of the ‘Villa Pini’ ClinicChietiItaly
  2. 2.Rheumatology Department of LucaniaSan Carlo Hospital, Contrada Macchia RomanaPotenzaItaly