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Elderly Onset Rheumatoid Arthritis

Differential Diagnosis and Choice of First-Line and Subsequent Therapy

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Abstract

Elderly onset rheumatoid arthritis (EORA) has been considered a benign form of rheumatoid arthritis (RA). However, it most probably encompasses different subsets of patients with distinct outcomes. According to data reported in the most recent studies directly comparing older and younger RA patients, it seems that, overall, the prognosis of EORA patients is not very different from that of other patients with this disease. However, some cases with negative rheumatoid factor and polymyalgia-like symptoms appear to be a distinct subset with a different genetic basis and a more benign course.

The differential diagnosis of EORA from other rheumatological disorders that are prevalent in this stratum of the population, such as polymyalgia rheumatica, crystal-induced arthritis or osteoarthritis, may be complicated because these disorders can present with signs and symptoms similar to those of RA in some circumstances. A prompt diagnosis of true RA is important because early treatment should be implemented.

It is recommended that therapy of EORA be tailored according to disease activity, with the aim of achieving clinical remission or the lowest possible level of disease activity in order to minimize potential functional sequelae. Co-morbidities and drug toxicity profiles are major considerations when choosing the most suitable therapy for EORA patients. Prudent use and careful follow-up of all treatments are also required because of the increased risk of adverse events in elderly patients. However, no special contraindications to the use of disease-modifying antirheumatic drugs in this age group apply, and use of biological therapies currently used in younger RA patients has also been described in these patients. Therefore, a therapeutic strategy for first-line and subsequent treatment that is in accordance with the disease activity of patients with EORA is suggested.

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References

  1. Rasch EK, Hirsch R, Paulose-Ram R, et al. Prevalence of rheumatoid arthritis in persons 60 years of age and older in the United States. Arthritis Rheum 2003; 48: 917–26

    Article  PubMed  Google Scholar 

  2. Carbonell J, Cobo T, Descalzo MA, et al. The incidence of rheumatoid arthritis in Spain: results from a nationwide primary care registry. Rheumatology 2008; 47(7): 1088–92

    Article  PubMed  CAS  Google Scholar 

  3. Alamanos Y, Voulgari PV, Drosos AA. Incidence and prevalence of rheumatoid arthritis, based on the 1987 ACR criteria: a systematic review. Semin Arthritis Rheum 2006; 36: 182–8

    Article  PubMed  Google Scholar 

  4. Laiho K, Tuomilehto J, Tilvis R. Prevalence of rheumatoid arthritis and musculoskeletal diseases in the elderly population. Rheumatol Int 2001; 20: 85–7

    Article  PubMed  CAS  Google Scholar 

  5. Kent PD, Matteson EL. Clinical features and differential diagnosis. In: St Clair EW, Pisetsky DS, Haynes BF, editors. Rheumatoid arthritis. Philadelphia (PA): Lippincott Williams & Wilkins, 2004: 11–25

    Google Scholar 

  6. Symmonds DPM, Barrett EM, Bankhead CR, et al. The incidence of rheumatoid arthritis in the United Kingdom: results from the Norfolk Arthritis Register. Br J Rheumatol 1994; 33: 735–9

    Article  Google Scholar 

  7. Gabriel SE, Crowson CS, O’Fallon WM. The epidemiology of rheumatoid arthritis in Rochester, Minnesota, 1955–1985. Arthritis Rheum 1999; 42: 415–20

    Article  PubMed  CAS  Google Scholar 

  8. Stastny P. Association of B cell alloantigen Drw4 with rheumatoid arthritis. N Engl J Med 1978; 298: 869–71

    Article  PubMed  CAS  Google Scholar 

  9. Gregersen PK, Silver J, Winchester RJ. The shared epitope hypothesis: an approach to understanding the molecular genetics of susceptibility to rheumatoid arthritis. Arthritis Rheum 1987; 30: 1205–13

    Article  PubMed  CAS  Google Scholar 

  10. Fries JF, Wolfe F, Apple R, et al. HLA-DRB1 genotype associations in 793 white patients from a rheumatoid arthritis inception cohort: frequency, severity, and treatment bias. Arthritis Rheum 2002; 46: 2320–9

    Article  PubMed  CAS  Google Scholar 

  11. Mattey DL, Hassell AB, Dawes PT, et al. Independent association of rheumatoid factor and the HLA-DRB1 shared epitope with radiographic outcome in rheumatoid arthritis. Arthritis Rheum 2001; 44: 1529–33

    Article  PubMed  CAS  Google Scholar 

  12. Weyand CM, Hicok KC, Conn DL, et al. The influence of HLA-DRB1 genes on disease severity in rheumatoid arthritis. Ann Intern Med 1992; 117: 801–6

    PubMed  CAS  Google Scholar 

  13. Gonzalez-Gay MA, Hajeer AH, Dababneh A, et al. Seronegative rheumatoid arthritis in elderly and polymyalgia rheumatica have similar patterns of HLA association. J Rheumatol 2001; 28: 122–5

    PubMed  CAS  Google Scholar 

  14. Wu H, Khanna D, Park G, et al. Interaction between RANKL and HLA-DRB1 genotypes may contribute to younger age of onset of seropositive rheumatoid arthritis in an inception cohort. Arthritis Rheum 2004; 50: 3093–103

    Article  PubMed  CAS  Google Scholar 

  15. Cecil RS, Krammerer WH. Rheumatoid arthritis in the aged. Am J Med 1951; 13: 439–45

    Article  Google Scholar 

  16. Van Schaardenburg D, Breedweld FC. Elderly-onset rheumatoid arthritis. Semin Arthritis Rheum 1994; 23(6): 367–78

    Article  PubMed  Google Scholar 

  17. Kavanaugh AF. Rheumatoid arthritis in the elderly: is it a different disease? Am J Med 1997; 103(6A): 40S–8S

    Article  PubMed  CAS  Google Scholar 

  18. Deal CL, Meenan RD, Goldenberg DL, et al. The clinical features of elderly-onset rheumatoid arthritis. Arthritis Rheum 1985; 28: 987–94

    Article  PubMed  CAS  Google Scholar 

  19. Healey LA. Rheumatoid arthritis in the elderly. Clin Rheum Dis 1986; 12: 173–9

    PubMed  CAS  Google Scholar 

  20. Bajocchi G, La Corte R, Locaputo A, et al. Elderly onset rheumatoid arthritis: clinical aspects. Clin Exp Rheumatol 2000; 18Suppl. 20: S49–50

    PubMed  CAS  Google Scholar 

  21. Ferraccioli GF, Cavalieri F, Mercandati M, et al. Clinical features, scintiscan characteristics and x-ray progression of late onset rheumatoid arthritis. Clin Exp Rheumatol 1984; 2: 157–61

    PubMed  CAS  Google Scholar 

  22. Van der Heijde DMFM, van Reil PLCM, van Leeuwen MA, et al. Older versus younger onset rheumatoid arthritis: results at onset and after 2 years of a prospective follow-up study of early rheumatoid arthritis. J Rheumatol 1991; 18: 1285–9

    PubMed  Google Scholar 

  23. Pease CT, Bhakta BB, Devlin J, et al. Does the age of onset of rheumatoid arthritis influence phenotype? A prospective study of outcome and prognostic factors. Rheumatology (Oxford) 1999; 38: 228–34

    Article  CAS  Google Scholar 

  24. Calvo-Alén J, Corrales A, Sanchez-Andrada S, et al. Outcome of late-onset rheumatoid arthritis. Clin Rheumatol 2005; 24: 485–9

    Article  PubMed  Google Scholar 

  25. Bukhari M, Lunt M, Barton A, et al. Increasing age at symptom onset is associated with worse radiological damage at presentation in patients with early inflammatory polyarthritis. Ann Rheum Dis 2007; 66: 389–93

    Article  PubMed  Google Scholar 

  26. Farragher TM, Goodson NJ, Naseem H, et al. Association of HLA-DRB1 gene with premature death, particularly from cardiovascular disease, in patients with rheumatoid arthritis and inflammatory polyarthritis. Arthritis Rheum 2008; 58: 359–69

    Article  PubMed  Google Scholar 

  27. Naz SM, Farragher TM, Bunn DK, et al. The influence of age at symptom onset and length of follow-up on mortality in patients with recent-onset inflammatory polyarthritis. Arthritis Rheum 2008; 58: 985–9

    Article  PubMed  Google Scholar 

  28. Mackenzie AH. Differential diagnosis of rheumatoid arthritis. Am J Med 1988; 85Suppl. 4A: 2–11

    Article  PubMed  CAS  Google Scholar 

  29. Hoffman GS. Polyarthritis: the differential diagnosis of rheumatoid arthritis. Semin Arthritis Rheum 1978; 8(2): 115–41

    Article  PubMed  CAS  Google Scholar 

  30. Tutuncu Z, Kavanaugh A. Rheumatic disease in the elderly: rheumatoid arthritis. Rheum Dis Clin N Am 2007; 33: 57–70

    Article  Google Scholar 

  31. Steinbach LS, Resnick D. Calcium pyrophosphate dehydrate crystal deposition disease revisited. Radiology 1996; 200(1): 1–9

    PubMed  CAS  Google Scholar 

  32. Arnett FC. Seronegative spondyloarthropathies. Bull Rheum Dis 1987; 37: 1–12

    PubMed  CAS  Google Scholar 

  33. Palazzi C, Olivieri I, Petricca A, et al. Rheumatoid arthritis or psoriatic symmetric polyarthritis: a difficult differential diagnosis. Clin Exp Rheumatol 2002; 20: 3–4

    PubMed  CAS  Google Scholar 

  34. Olivieri I, Palazzi C, Peruz G, et al. Management issues with elderly-onset rheumatoid arthritis: an update. Drugs Aging 2005; 22(10): 809–22

    Article  PubMed  CAS  Google Scholar 

  35. Dubost JJ, Sauvezie B. Late onset peripheral spondyloarthropathy. J Rheumatol 1989; 16: 1214–7

    PubMed  CAS  Google Scholar 

  36. Olivieri I, Salvarani C, Cantini F, et al. Ankylosing spondylitis and undifferentiated spondyloarthropathies: a clinical review and description of a disease subset with older age at onset. Curr Opin Rheumatol 2001; 13: 280–4

    Article  PubMed  CAS  Google Scholar 

  37. Bagratuni L. Prognosis in anarthritic rheumatoid syndrome. BMJ 1963; 1: 513–8

    Article  PubMed  CAS  Google Scholar 

  38. González-Gay MA, García-Porrúa C, Salvarani C, et al. The spectrum of conditions mimicking polymyalgia rheumatica in north-western Spain. J Rheumatol 2000 Sep; 27(9): 2179–84

    PubMed  Google Scholar 

  39. González-Gay MA, García-Porrúa C, Salvarani C, et al. Diagnostic approach in a patient presenting with polymyalgia. Clin Exp Rheumatol 1999 May–Jun; 17(3): 276–8

    PubMed  Google Scholar 

  40. Dimant J. Rheumatoid arthritis in the elderly presenting as polymyalgia rheumatica. J Am Geriatr Soc 1979; 27: 183–5

    PubMed  CAS  Google Scholar 

  41. Healey LA, Sheets PK. The relation of polymyalgia rheumatica to rheumatoid arthritis. J Rheumatol 1988; 15: 750–2

    PubMed  CAS  Google Scholar 

  42. Hunder GG, Gorozny J, Weyland C. Is seronegative RA in the elderly the same as polymyalgia rheumatica? Bull Rheum Dis 1994; 43: 1–3

    PubMed  CAS  Google Scholar 

  43. López-Hoyos M, Ruiz de Alegria C, Blanco R, et al. Clinical utility of anti-CCP antibodies in the differential diagnosis of elderly-onset rheumatoid arthritis and polymyalgia rheumatica. Rheumatology (Oxford) 2004; 43: 655–7

    Article  Google Scholar 

  44. Lange U, Piegsa M, Teichmann J, et al. Ultrasonography of the glenohumeral joints: a helpful instrument in differentiation in elderly onset rheumatoid arthritis and polymyalgia rheumatica. Rheumatol Int 2000; 19: 185–9

    Article  PubMed  CAS  Google Scholar 

  45. Cantini F, Salvarani C, Niccoli L, et al. Fat suppression magnetic resonance imaging in shoulders of patients with polymyalgia rheumatica. J Rheumatol 2004; 31: 120–4

    PubMed  Google Scholar 

  46. Ehrlich GE. Erosive osteoarthritis: presentation, clinical pearls, and therapy. Curr Rheumatol Rep 2001; 3(6): 484–8

    Article  PubMed  CAS  Google Scholar 

  47. McCarty DJ, ÓDuffy JD, Pearson L, et al. Remitting seronegative symmetrical synovitis with pitting edema. RS3PE syndrome. JAMA 1985; 254: 2753–7

    Google Scholar 

  48. Russell EB, Hunter JB, Pearson L, et al. Remitting, seronegative, symmetrical synovitis with pitting edema: 13 additional cases. J Rheumatol 1990; 17: 633–9

    PubMed  CAS  Google Scholar 

  49. Sibilia J, Friess S, Schaeverbeke T, et al. Remitting seronegative symmetrical synovitis with pitting edema (RS3PE): a form of paraneoplastic polyarthritis? J Rheumatol 1999; 26: 115–20

    PubMed  CAS  Google Scholar 

  50. Caldwell DS, McCallum RM. Rheumatologic manifestation of cancer. Med Clin North Am 1986; 70: 385–417

    PubMed  CAS  Google Scholar 

  51. Stummvoll GH, Aringer M, Machold KP, et al. Cancer polyarthritis resembling rheumatoid arthritis as a first sign of hidden neoplasm: report of two cases and review of the literature. Scand J Rheumatol 2001; 30: 40–4

    Article  PubMed  CAS  Google Scholar 

  52. Pease C, Keat A. Arthritis as the main or the only symptom of hepatitis B infection. Postgrad Med J 1985; 61(716): 545–7

    Article  PubMed  CAS  Google Scholar 

  53. Zuckerman E, Keren D, Rozembaun M, et al. Hepatitis C virus-related arthritis: characteristics and response to therapy with interferon alpha. Clin Exp Rheumatol 2000; 18(5): 579–84

    PubMed  CAS  Google Scholar 

  54. Studenski SA, Ward MM. Pharmacology and the elderly. In: Harris Jr ED, Budd RC, Firestein GS, et al., editors. Kelley’s textbook of rheumatology. 7th ed. Philadelphia (PA): Elsevier Saunders, 2005: 961–6

    Google Scholar 

  55. Walker J, Wynne H. The frequency and severity of adverse drug reactions in older people. Age Ageing 1994; 23: 255–9

    Article  PubMed  CAS  Google Scholar 

  56. Bird HA. Drugs and the elderly. Ann Rheum Dis 1990; 49: 1021–4

    Article  PubMed  CAS  Google Scholar 

  57. Combe B. Early rheumatoid arthritis: strategies for prevention and management. Best Pract Res Clin Rheumatol 2007; 21: 27–42

    Article  PubMed  Google Scholar 

  58. Smolen JS, Aletaha D, Machold KP. Therapeutic strategies in early rheumatoid arthritis. Best Pract Res Clin Rheumatol 2005; 19: 163–77

    Article  PubMed  CAS  Google Scholar 

  59. Machold KP, Stamm TA, Eberl GJM, et al. Very recent onset arthritis: clinical, laboratory and radiological findings during the first year of disease. J Rheumatol 2002; 29: 2278–87

    PubMed  Google Scholar 

  60. Van der Heide A, Jacobs JWG, Bjilsma JWJ, et al. The effectiveness of early treatment with “second line” anti-rheumatic drugs: a randomized, controlled trial. Ann Intern Med 1996; 124(8): 699–707

    PubMed  Google Scholar 

  61. Stenger AA, van Leeuwen MA, Houtman PM, et al. Early effective suppression of inflammation in rheumatoid arthritis reduces radiographic progression. Br J Rheumatol 1998; 37: 1157–63

    Article  PubMed  CAS  Google Scholar 

  62. Lard LR, Visser H, Speyer I, et al. Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies. Am J Med 2001; 111: 446–51

    Article  PubMed  CAS  Google Scholar 

  63. Nell V, Machold KP, Eberl G, et al. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology (Oxford) 2004; 43: 906–17

    Article  CAS  Google Scholar 

  64. Anderson JJ, Felson DT. Factors predicting response to treatment in rheumatoid arthritis: the importance of disease duration. Arthritis Rheum 2000; 43: 22–9

    Article  PubMed  CAS  Google Scholar 

  65. Aletaha D, Smolen JS. The rheumatoid arthritis patient in the clinic: comparing more than 1300 consecutive DMARD courses. Rheumatology (Oxford) 2002; 41: 1367–74

    Article  CAS  Google Scholar 

  66. Castro-Rueda H, Kavanaugh A. Biologic therapy for early rheumatoid arthritis: the latest evidence. Curr Opin Rheumatol 2008; 20: 314–9

    Article  PubMed  Google Scholar 

  67. Smolen JS, van der Heijde DMFM, St Clair W. Predictors of joint damage in patients with early rheumatoid arthritis treated with high-dose methotrexate with or without concomitant infliximab: results from the ASPIRE trial. Arthritis Rheum 2006; 54: 702–10

    Article  PubMed  CAS  Google Scholar 

  68. Combe B, Landewe R, Lukas C, et al. EULAR recommendations for the management of early arthritis. Report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2007; 66(1): 34–45

    Article  PubMed  CAS  Google Scholar 

  69. Bressolle F, Bologna C, Kinowski JM, et al. Total and free methotrexate pharmacokinetics in elderly patients with rheumatoid arthritis: a comparison with young patients. J Rheumatol 1997; 24(10): 1903–9

    PubMed  CAS  Google Scholar 

  70. Kristensen LO, Weismann K, Hutters L. Renal function and the rate of disappearance of methotrexate from serum. Eur J Clin Pharmacol 1975; 8: 439–44

    Article  PubMed  CAS  Google Scholar 

  71. Felson DT, Anderson JJ, Meenan RF. Use of short-term efficacy/toxicity tradeoffs to select second-line drugs in rheumatoid arthritis: a metaanalysis of published clinical trials. Arthritis Rheum 1992; 35(10): 1117–25

    Article  PubMed  CAS  Google Scholar 

  72. Wernick R, Smith DL. Central nervous system toxicity associated with weekly low dose methotrexate therapy. Arthritis Rheum 1989; 32: 770–5

    Article  PubMed  CAS  Google Scholar 

  73. MacKinnon SK, Starkebaum G, Wilkens RF. Pancytopenia associated with low dose pulse methotrexate therapy in the treatment of rheumatoid arthritis. Semin Arthritis Rheum 1985; 15: 119–26

    Article  PubMed  CAS  Google Scholar 

  74. Weinblatt ME. Rheumatoid arthritis in 2003: where are we now with treatment? Ann Rheum Dis 2003; 62 Suppl. ii: ii94–6

    PubMed  Google Scholar 

  75. Smolen JS, Sokka T, Pincus T, et al. A proposed treatment algorithm for rheumatoid arthritis: aggressive therapy, methotrexate, and quantitative measures. Clin Exp Rheumatol 2003; 21Suppl. 31: S209–10

    PubMed  CAS  Google Scholar 

  76. Grigor C, Capell HA, Stirling A, et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet 2004; 364: 263–9

    Article  PubMed  Google Scholar 

  77. Gardner G, Furst DE. Disease-modifying antirheumatic drugs: potential effects in older patients. Drugs Aging 1995; 7(6): 420–37

    Article  PubMed  CAS  Google Scholar 

  78. Wolfe F, Cathey MA. The effect of age on methotrexate efficacy and toxicity. J Rheumatol 1991; 18(7): 973–7

    PubMed  CAS  Google Scholar 

  79. Drosos A. Methotrexate intolerance in elderly patients with rheumatoid arthritis: what are the alternatives? Drugs Aging 2003; 20: 723–36

    Article  PubMed  CAS  Google Scholar 

  80. Smolen JS, Kalden JR, Scott DL, et al. Efficacy and safety of leflunomide compared with placebo and sulphasalazine in active rheumatoid arthritis: a double blind, randomised, multicenter trial. European Leflunomide Study Group. Lancet 1999; 353: 259–66

    Article  PubMed  CAS  Google Scholar 

  81. Maddison P, Kiely P, Kirkham B, et al. Leflunomide in rheumatoid arthritis: recommendations though a process of consensus. Rheumatology (Oxford) 2005; 44: 280–6

    Article  CAS  Google Scholar 

  82. Hurst S, Kallan MJ, Wolfe F, et al. Methotrexate, hydroxychloroquine, and intramuscular gold in rheumatoid arthritis: relative area under the curve effectiveness and sequence effects. J Rheumatol 2002; 29: 1639–45

    PubMed  CAS  Google Scholar 

  83. Suarez-Almazor ME, Belseck E, Shea B, et al. Antimalarials for treating rheumatoid arthritis. Cochrane Database Syst Rev 2000; (2): CD000959

    Google Scholar 

  84. Mavrikakis I, Sfikakis PP, Mavrikakis E, et al. The incidence of irreversible retinal toxicity in patients treated with hydroxychloroquine: a reappraisal. Ophthalmology 2003; 110: 1321–6

    Article  PubMed  Google Scholar 

  85. Rigaudiere F, Ingster-Moati I, Hache JC, et al. Up-dated ophthalmological screening and follow-up management for long-term antimalarial treatment [in French]. J Fr Ophthalmol 2004; 27: 191–4

    Article  CAS  Google Scholar 

  86. O’Dell JR, Leff R, Paulsen G, et al. Treatment of rheumatoid arthritis with methotrexate and hydroxychloroquine, methotrexate and sulfasalazine, or a combination of the three medications. Arthritis Rheum 2002; 46(5): 1164–70

    Article  PubMed  CAS  Google Scholar 

  87. Choy EHS, Smith C, Doré CJ, et al. A meta-analysis of the efficacy and toxicity of combining disease-modifying antirheumatic drugs in rheumatoid arthritis based on patient withdrawal. Rheumatology 2005; 44: 1414–21

    Article  PubMed  CAS  Google Scholar 

  88. Dale J, Alcorn N, Capell H, et al. Combination therapy for rheumatoid arthritis: methotrexate and sulfasalazine together or with other DMARDs. Nat Clin Pract Rheum 2007; 3(8): 450–8

    Article  CAS  Google Scholar 

  89. Svartz N. The treatment of rheumatic polyarthritis with acid azo compounds. Rheumatism 1948; 4: 56–60

    Google Scholar 

  90. Taggart AJ, McDermott B, Delargy M, et al. The pharmacokinetics of sulphasalazine in young and elderly patients with rheumatoid arthritis. Scand J Rheumatol Suppl 1987; 64: 29–36

    Article  PubMed  CAS  Google Scholar 

  91. Haagsma CJ. Clinically important drug interactions with disease-modifying antirheumatic drugs. Drugs Aging 1998; 13(4): 281–9

    Article  PubMed  CAS  Google Scholar 

  92. Pinals RS, Kaplan SB, Lawson JG, et al. Sulfasalazine in rheumatoid arthritis: a double blind, placebo-controlled trial. Arthritis Rheum 1986; 29(12): 1427–34

    Article  PubMed  CAS  Google Scholar 

  93. Suarez-Almazor ME, Belseck E, Shea B, et al. Sulfasalazine for rheumatoid arthritis. Cochrane Database Syst Rev 2000; (2): CD000958

    Google Scholar 

  94. Verstappen SM, Jacobs JW, van de Veen MJ, et al. Intensive treatment with methotrexate in early rheumatoid arthritis: aiming for remission. Computer Assisted Management in Early Rheumatoid Arthritis (CAMERA, an open-label strategy trial). Ann Rheum Dis 2007; 66: 1443–9

    Article  PubMed  CAS  Google Scholar 

  95. Smolen JS, Aletaha D. Activity assessments in rheumatoid arthritis. Curr Opin Rheumatol 2008; 20: 306–13

    Article  PubMed  Google Scholar 

  96. Le Loet X, Berthelot JM, Cantagrel A, et al. Clinical practice decision tree for the choice of the first disease modifying antirheumatic drug for very early rheumatoid arthritis: a 2004 proposal of the French Society of Rheumatology. Ann Rheum Dis 2006; 65(1): 45–50

    Article  PubMed  CAS  Google Scholar 

  97. Meyer O, De Bandt M, Berthelot JM, et al. Clinical practice format for choosing a second-line disease modifying anti-rheumatic drug in early rheumatoid arthritis after failure of 6 months’ first line DMARD therapy. Joint Bone Spine 2007; 74(1): 73–8

    Article  PubMed  Google Scholar 

  98. Svensson B, Boonen A, Albertsson K, et al. Low-dose prednisolone in addition to the initial disease-modifying antirheumatic drug in patients with early active rheumatoid arthritis reduces joint destruction and increases the remission rate: a two-year randomized trial. Arthritis Rheum 2005; 52: 3360–70

    Article  PubMed  CAS  Google Scholar 

  99. Kirwan JR. The effect of glucocorticoids on joint destruction in rheumatoid arthritis. The Arthritis and Rheumatism Council Low-Dose Glucocorticoid Study Group. N Engl J Med 1995; 333: 142–6

    Article  PubMed  CAS  Google Scholar 

  100. Wassenberg S, Rau R, Steinfeld P, et al. Very low-dose prednisolone in early rheumatoid arthritis retards radio-graphic progression over two years: a multicenter, double-blind, placebo-controlled trial. Arthritis Rheum 2005; 52: 3371–80

    Article  PubMed  CAS  Google Scholar 

  101. Furst DE, Breedveld FC, Kalden JR, et al. Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2007. Ann Rheum Dis 2007; 66Suppl. III: iii2–22

    Article  PubMed  CAS  Google Scholar 

  102. Genevay S, Finckh A, Ciurea A, et al. Tolerance and effectiveness of anti-tumor necrosis-alpha therapies in elderly patients with rheumatoid arthritis: a population-based cohort study. Arthritis Rheum 2007; 57: 679–85

    Article  PubMed  Google Scholar 

  103. Ornetti P, Chevillotte H, Zerrak A, et al. Anti-tumor necrosis-alpha therapy for rheumatoid and other inflammatory arthropathies: update on safety in older patients. Drugs Aging 2006; 23(11): 855–60

    Article  PubMed  CAS  Google Scholar 

  104. Fleischmann R, Iqbal I. Risk: benefit profile of etanercept in elderly patients with rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis. Drugs Aging 2007; 24(3): 239–54

    Article  PubMed  CAS  Google Scholar 

  105. Van der Kooij SM, Allart CF, Dijkmans BAC, et al. Innovative treatment strategies for patients with rheumatoid arthritis. Curr Opin Rheumatol 2008; 20: 287–94

    Article  PubMed  Google Scholar 

  106. Van der Bijl AE, Goekoop-Ruiterman YP, de Vries-Bouwstra JK, et al. Infliximab and methotrexate as induction therapy in patients with early rheumatoid arthritis. Arthritis Rheum 2007; 56: 2129–34

    Article  PubMed  CAS  Google Scholar 

  107. Lee SJ, Reed G, Soto L, et al. Persistence of clinical benefit in rheumatoid arthritis after discontinuation of TNF-inhibitor therapy: analysis from the CORRONA database [abstract]. Arthritis Rheum 2007; 56: S311

    Article  CAS  Google Scholar 

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No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Division of Rheumatology, Hospital Sierrallana, Torrelavega, Universidad de Cantabria, Barrio de Ganzo s/n, 39300, Torrelavega, Cantabria, Spain

    Juan Ignacio Villa-Blanco &  Jaime Calvo-Alén

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Villa-Blanco, J.I., Calvo-Alén, J. Elderly Onset Rheumatoid Arthritis. Drugs Aging 26, 739–750 (2009). https://doi.org/10.2165/11316740-000000000-00000

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