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Rheumatoid Arthritis

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Geriatric Diseases

Abstract

The review provides an overview of the prevalence and mechanisms, with the main focus on age at onset. One-third of the patients with rheumatoid arthritis have their first symptom after the age of 60 years. In the elderly, RA takes two forms: (i) continuing into old age with younger-onset RA (YORA) and (ii) elderly-onset RA (EORA). Clinical emphasis is placed on these differences, for failure to recognise them may result in delay in diagnosis and treatment.

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References

  1. Arthritis Foundation of South Africa. A brief history of RA and its treatment. http://healthunlocked.com/arthritisfoundatio/posts/427232/q-brief-history-of-ra-and-its-treatment. Accessed 2 February 2016.

  2. Arcini C. Rheumatoid Arthritis-Rare reality as recovered among scanian skeletal remains from Viking and Medieval Times. Sydsvenska Medicinhistoriska. 1992;18:11–21.

    Google Scholar 

  3. Short CL. The antiquity of rheumatoid arthritis. Arthritis and Rheumatism. 1974;17(3):193–205.

    Article  CAS  PubMed  Google Scholar 

  4. Basisht G, Singh RH, Chandola H. Management of rheumatoid arthritis (Aamavata) using symbiohealth health care system. Ayu. 2012; 33(4):466–474.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Entezami P, Fox DA, Clapmsan PJ, Chung KC. Historical perspective on the etiology of rheumatoid arthritis. Han Clin. 2011;27(1):1–10.

    Article  Google Scholar 

  6. Panush. Why did rheumatoid arthritis begin in 1800? http://www.the-rheumatologist.org/article/why-did-rheumatoid–arthritis-begi-in-1800/?singlepage=1. Accessed 1 February 2016.

  7. Mandal A. Arthritis history. http://www.news-medical.net/health/Arthritis-History.aspx accessed 1 February 2016.

  8. Appleboom T. ed Art, History and Antiquity of rheumatic Disease. Elsevier, Brussels, Erasmus FoundatioN. 1987.

    Google Scholar 

  9. Riley JC. Estimates of regional and global life expectancy. Population and development review. 2005;31(3):537–543.

    Article  Google Scholar 

  10. Majitha V, Geraci SA. Rheumatoid Arthritis: Diagnosis and Management. Am J Med. 2007;120:936–939.

    Article  Google Scholar 

  11. Kahkenberg JM, Fox DA. Advances in the medical treatment of rheumatoid arthritis. Han Clin. 2011;27(11):11–20.

    Article  Google Scholar 

  12. Gibofsky A. Overview of epidemiology pathophysiology and diagnosis of rheumatoid arthritis. Am J Manag Care. 2012;18(3suppl)S295=30.

    Google Scholar 

  13. Ruffing V, Bingham CO. Rheumatoid arthritis, signs and symptoms. www.hopkinsarhitis.org/arhritis-info/rheumatod:arthtitis/ra-symptoms/

  14. Choy E. Understanding the dynamics: pathways involved in the pathogenesis of rheumatoid arthritis. Rheumatology. 2012;51(suppl 5):v3-v11. https://doi.org/10.1093/rheumatology/kes113.

    Article  CAS  PubMed  Google Scholar 

  15. Abdel-Nasser AM, Rasker JJ, Valkenburg HA. Epidemiological and clinical aspects relating to the variability of rheumatoid arthritis. Semi Arthritis Rheum. 1997;27(2):123–40.

    Article  CAS  Google Scholar 

  16. Alamanos Y, Voulgari PV, Drosos AA. Incidence and prevalence of rheumatoid arthritis based on the 1987 American College of Rheumatology criteria: a systematic review. Semi Arthritis Theum 2006;36(3):182–8.

    Article  Google Scholar 

  17. Kvien TK. Epidemiology and burden of illness of rheumatoid arthritis. Pharmaco Economics. 2004;32:1–12.

    Article  Google Scholar 

  18. Negoescu A, Ostor AJ. Early recognition improves prognosis in elderly onset RA. Practitioner. 2014; 258(1767):11–4,2.

    PubMed  Google Scholar 

  19. Diaz-Borjon A. Guidelines for the use of conventional and newer disease-modifying antirheumatic drugs in elderly patients with rheumatoid arthritis. Drugs Aging. 2009;26(4):273–93.

    Article  CAS  PubMed  Google Scholar 

  20. Turkcapar N, Demir O, Atli T, Kopuk M, Turgay H, Kinikli G, et al. Late onset rheumatoid arthritis: clinical and laboratory comparisons with younger onset patients. Arch Gerontol Geriatr. 2009;42:225–231.

    Article  Google Scholar 

  21. Woodworth T, Ranganath V, Furst DE. Rheumatoid arthritis in the elderly: recent advances in understanding the pathogenesis, risk factors, comorbidities and risk-benefit of treatments. Aging Health 9(2):167–178. https://doi.org/10.2217/ahe.13.15.

  22. Hopkins A, Lozado CJ. Elderly onset rheumatoid arthritis. A distinct clinical entity? Clin Geriatrics. 2008;16:40–46.

    Google Scholar 

  23. Laiho K, Teiomilehto J, Tavis R. Prevalence of rheumatoid arthritis and musculoskeletal disease in the elderly population. Rheumatol Int. 2001;20(3):85–7.

    Article  CAS  PubMed  Google Scholar 

  24. Rasch EK, Harsch R, Paulose-Ram R, Hochberg MC. Prevalence of rheumatoid arthritis in persons 60 years of age and older in the United States: Effect of different methods of case classification. Arthritis Rheum. 2003; 48(6):917–926.

    Google Scholar 

  25. Symmons D, Turner G, Webb R, Asten P, Burett E, Lunt M, et al. The prevalence of rheumatoid arthritis in the United Kingdom: new estimates for a new century. Rheumatology. 2002;41(7):793–800.

    Article  CAS  PubMed  Google Scholar 

  26. Olivieri N, Pipitone N, D’Angelo S, Padula A, Salvarani C. Late-onset rheumatoid arthritis and late-onset spondyloarthritis. Clin Exp Rheumatol 2009; 27(Suppl55):S139-S145.

    CAS  PubMed  Google Scholar 

  27. Filipowicz-Sosnowski A, Rupinski. Elderly onset rheumatoid arthritis. Pol Arch Med Wewn. 2008;118 Suppl:36–42.

    Google Scholar 

  28. Amador-Patarroyo MJ, Rodriguez A R, Oritz GM. How does age at onset influence the outcome of autoimmune diseases? Autoimmune Diseases 2012(2012, Article ID251730, 7 pages. https://doi.org/10.1155/2012/251730.

  29. Evcik D. An overview of late-onset rheumatoid arthritis. Editorial. Turk J Rheumatol. 2013;28(2):67–68.

    Article  Google Scholar 

  30. Deal CL, Meenan RF, Goldenberg DL, Anderson JJ, Sack B, Pastan RS, et al. The clinical features if elderly onset rheumatoid arthritis: A comparison with younger onset disease of similar duration. Arthritis Rheum. 1985;28(9):987–94.

    Article  CAS  PubMed  Google Scholar 

  31. Bajoochi G, La Corte R, Locaputo A, Govoni M,Trotta F. Elderly onset rheumatoid arthritis: clinical aspects. Clin Exp Rheumatol. 2000;18(4 Suppl 20): S49–50.

    Google Scholar 

  32. Kurko J, Besenyei T, Laki J, Glant TT, Mihecz K, Szekanecz Z. Genetics of rheumatoid arthritis-a comprehensive review. Clin Rev Allergy Immunol. 2013;45(2):170–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Kawabata K, Yamamoto K. Recent advances in the pathogenesis of rheumatoid arthritis. Clin Calcium. 2009;19(3):303–9. doi:CliCa0903303309.

    Google Scholar 

  34. Lee W-Y, Chen H-Y, Chen K-C, Chen Y-C. Treatment of rheumatoid arthritis with traditional Chinese medicine. BioMed Res Int. https://doi.org/10.1155/2014/528018. Accessed 30 january 2016.

  35. Plenge RM, Seielstad M, Padyukov L, Lee AT, Remmers EF, Ding B, et al. ‘TRAFI-C5 as a risk locus for rheumatoid arthritis-a genomewide study. NEJM. 2007;357(12):1199–1209.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Silman AJ, Macgregor AJ, Thomson W, Holigan S, Carthy D, Farhan A, et al. Twin concordance rates for rheumatoid arthritis: results of a nationwide study. Brit J Rheumatol. 1993;32(10):903–907.

    Article  CAS  Google Scholar 

  37. Bellamy N, Duffy D, Martin N, Mathews J. Rheumatoid arthritis in twins: a study of aetiopathogenesis based on the Australian Twin Registry. Ann Rheumat Dis. 2010;69(1):70–81.

    Article  Google Scholar 

  38. Agarwal SK. Biologic agents in rheumatoid arthritis: an update for managed care professionals. J Manag Care Pharm. 2011;17(SupplIB) S14–8.

    PubMed  Google Scholar 

  39. Smolen JS, Steiner G. Therapeutic strategies for rheumatoid arthritis. Nat Rev Drug Discov. 2003;2:47–88.

    Article  Google Scholar 

  40. Smolon JS, Aletana D, Koeller M, Wiseman MH, Emery P. New therapies for the treatment of rheumatoid arthritis. Lancet. 2007;370;1861–74.

    Article  Google Scholar 

  41. Fantini F. New Drugs and treatment strategies for rheumatoid arthritis. Recent Prog Med. 2003;94(9):361–79.

    Google Scholar 

  42. McInnes IB, Schett G. Cytokines in the pathogenesis of rheumatoid arthritis. Nat Rev Immunol. 2007;7:429–4.

    Article  CAS  PubMed  Google Scholar 

  43. Firestein GS. Evolving concepts of rheumatoid arthritis. Nature. 2003;423:356–61.

    Article  CAS  PubMed  Google Scholar 

  44. Chikanza IC, Kingsley G, Panayi S. Peripheral blood and synovial fluid monocyte expression of interleukin-1 alpha and -1 beta during active rheumatoid arthritis. J Rheumatol. 1995;22:600–608.

    CAS  PubMed  Google Scholar 

  45. Fong KY, Boey ML, Koh WH, Feng PG. Cytokine concentrations in the synovial fluid and plasma of rheumatoid arthritis patients correlation with bony erosions. Clin Exp Rheumatol. 1994;12:55–58.

    CAS  PubMed  Google Scholar 

  46. Arend WP, Dayer JM. Cytokines and cytokine inhibitors or antagonists in rheumatoid arthritis. Arthritis Rheum. 1990;33:305–315.

    Article  CAS  PubMed  Google Scholar 

  47. van den Beg. Joint inflammation and cartilage destruction may occur unrecognized. Springer Semin Immunopathol. 1998;20:149–164.

    Article  Google Scholar 

  48. van den Lent PL, van De Loo FA, Holthuysen AE, van Den Berssalar LA, Vemeer H, van Den Bergh B. Major role for IL-1 but not for TNF in early cartilage damage in immune complex in mice. J Rheumatol. 1995;22:2250–2258.

    PubMed  Google Scholar 

  49. Chen DY, Hsieh TY, Chen YM, Hseih CW, Lan JL, Lin FJ. Proinflammatory cytokine profiles of patients with elderly onset rheumatoid arthritis: a comparison with younger onset disease. Gerontology. 2001;55(3):250–8.

    Article  Google Scholar 

  50. Choi Y, Arron JR, Townsend MJ. Promising bone-related therapeutic targets for rheumatoid arthritis. Nature Rev Rheumatol. 009;5:543–548.

    Google Scholar 

  51. Balandraud N, Roudier J, Roudier C,. Epstein-Barr virus and rheumatoid arthritis. Autoimun Rev. 2004;3:362–367.

    Article  CAS  Google Scholar 

  52. Costenbader KH, Karison EW. Epstein-Barr virus and rheumatoid arthritis: Is there a link? Arthritis Res Ther. 008;8(1):204. https://doi.org/10.1186/art893.

  53. Alvarez-Lafuente R, Fernandez-Gutierrez B, Miguel S, Jover JA, Rollin R, Loza E, et al. Analysis with a quantitative real time polymerase chain reaction. Am Rheum Dis. 2005;64:1357–1359.

    Article  CAS  Google Scholar 

  54. Mercado FB, Marshall RI, Kestor AC, Bartold PM. Relationship between rheumatoid arthritis and periodontitis. J Periodontol. 2001;72(6):779–87.

    Article  CAS  PubMed  Google Scholar 

  55. Kasser UR, Gleissner C, Dehne F, Michel A, Willershausen-Zonnchen B, Bolton WW. Risk of periodontal disease in patients with long standing rheumatoid arthritis. Arthritis Reum. 1997;40 (12):2248–51.

    Article  CAS  Google Scholar 

  56. Loyala-Rodrigues JP, Martinez-Martinez RE, Abud-Mendoza C, Patcho-Manin N, Seymour GJ. Rheumatoid arthritis and role of oral bacteria. J Oral Microbiol. 2010:2: https://doi.org/10.3402/jom.v210.5784.

  57. van Schaardenberg D. Rheumatoid arthritis in the elderly. Prevalence and optimal management. Drugs Aging. 1995;7:30–7.

    Article  Google Scholar 

  58. Grassi W, De Angelis R, Lamanna G, Cervini C. The clinical features of rheumatoid arthritis. Eur J Radiol. 1998; 27 Suppl 1:S18–24.

    Article  PubMed  Google Scholar 

  59. Rindfleisch JA, Muller D. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2005;72:1036–1047.

    Google Scholar 

  60. Bingham CO. Rheumatoid Pathophysiology. The John Hopkins Arthritis Center. http://www.hopkinsarthrtis.org/arthritis-info/rheumatoid–arthritis/ra-pathophysiology-2/ retrieved 27 August 2013.

  61. Ceccato F, Roverano S, Barrionucia A, Rillo O, Paira S. The role of anticyclic citrullinated peptide antibodies in the differential diagnosis of elderly onset rheumatoid arthritis and polymyalgia rheumatic. Clin Rheumatol. 2006; 25(6):854–7.

    Article  CAS  PubMed  Google Scholar 

  62. Lopez-Hoyos H, De Algeria R, Crespo BR, Pena M, Rodriguez-Valverde V, Mastinez-Taboada VM. Clinical utility of anti-CCP antibodies in the differential diagnosis of elderly onset rheumatoid arthritis and polymyalgia rheumatica. Rheumatology (Oxford). 2004; 43(5):655–7.

    Article  CAS  Google Scholar 

  63. Suresh E. Recent advances in rheumatoid arthritis. Postgrad Med J. 2010;86(1014):243–50.

    Article  PubMed  Google Scholar 

  64. Reouw LA, Mahler M. Closing the serological gap: promising novel biomarkers for the early diagnosis of rheumatoid arthritis. Autoimmune Rev. 2012; 12(2):18–32.

    Google Scholar 

  65. McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. NEJM. 2011;365:69 2205–2219.

    Article  CAS  PubMed  Google Scholar 

  66. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update.

    Google Scholar 

  67. Olivieri I, Palazzi C, Peruz G, Padula A. Management issues with elderly onset rheumatoid arthritis. an update. Drugs Aging. 2005;22(10): Seg -22.

    Article  Google Scholar 

  68. Zuckerman E, Keren D, Rozenbaum M, Toubi E, Slobodin G, Tamir A, et al. Hepatitis C virus-related arthritis: characteristics and response to therapy with interferon alpha. Clin Exp Reumatol. 2000;18:579–584.

    CAS  Google Scholar 

  69. Stenstrom CH, Minor MA. Evidence for the benefits of aerobic and strengthening exercise in rheumatoid artheritis. Arthritis Rheum. 2003;49:428–434.

    Article  PubMed  Google Scholar 

  70. Shaw K,Zochling J, Winzenberg T. Non-pharmacological interventions in rheumatoid arthritis. Aust Fam Physician. 2007;36:840–841.

    PubMed  Google Scholar 

  71. Tayar JH, Suarez-Almazor M. New understanding and approaches to treatment of rheumatoid arthritis. Br Med Bull. 2010; 94(1):201–214.

    Article  PubMed  Google Scholar 

  72. Kim GW, Lee NR, Pi RH, Lim YS, Lee YM, Lee JM, et al. IL-6 inhibitors for treatment of rheumatoid arthritis: past, present and future. Arch Pharm Res. 2015;38(5):575–584.

    Article  CAS  PubMed  Google Scholar 

  73. Waters L, Moots R. Recent advances in treatment and diagnosis of rheumatoid arthritis. prescriber.co.uk. 19 February 2014.

    Google Scholar 

  74. Buch MH, Emery P. New therapies in management of rheumatoid arthritis. Curr Opin Rheumatol. 2011; 23(3):250–251.

    Article  Google Scholar 

  75. Genovere MC, Kreme J, Zamarri O, Ludivico C, Krogulec M, Li Xie MS, et al. Baricitinib in patients with refractory rheumatoid arthritis. NEJM. 2016; 374:1243–1252.

    Article  Google Scholar 

  76. Therapeutic Guidelines. Rheumatology ,Version. 2006.

    Google Scholar 

  77. Calabrese LH. Rheumatoid arthritis and primary care: the case for early diagnosis and treatment. J Am Osteopath Assoc. 1999; 99(6): 313–21.

    Article  CAS  PubMed  Google Scholar 

  78. Fries JF. Current treatment paradigms in rheumatoid arthritis. Rheumatology (Oxford). 2000;39 Suppl 1:30–5.

    Article  Google Scholar 

  79. Gaffo A, Saag KG, Curtis JR. Treatment of rheumatoid arthritis. Am J Health Syst Pham. 2006; 63(24):2451–65 .

    Article  CAS  Google Scholar 

  80. Chen VF, Jobanputra P, Barton P, Jowell S, Bryan S, Claark W, et al. A systematic review of the effectiveness of adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis in adults and an economic evaluation of their cost-effectiveness. Health Technol Assess. 2006;10:iii–iv,1–229.

    Google Scholar 

  81. Yazici Y, Paget SA. Elderly on set rheumatoid arthritis. Dis Clin North. Am 2000;26:517–26.

    Article  CAS  Google Scholar 

  82. Gabriel SE, Jaakkimaimen I, Bombardier C. Risk of serious systemic complications related to use of non-steroidal inflammatory drugs. A metaanalysis. Ann Int Med. 1991;115:787–96.

    Article  CAS  PubMed  Google Scholar 

  83. Clifford LJ. Use of NSAIDs in treating patients with arthritis. Arthritis Res Therapy. 2013;15(3):52. https://doi.org/10.1186/ar4o74.

    Google Scholar 

  84. Emery P, Breedveld FC, Dougados M, Kalden JR, Schiff MH, Smolen JS, et al. Early referral recommendations for newly diagnosed rheumatoid arthritis: evidence based development of a clinical guide. Am Rheum Dis. 2002;61:290–7.

    Article  CAS  Google Scholar 

  85. Boers M. Rheumatoid arthritis. Treatment of early disease. Rheum Dis Clin North Am. 2001;27:405–14

    Article  CAS  PubMed  Google Scholar 

  86. Fleischmann R, Iqbal T, Nandeshwar P, Quiceo A, Safety and efficacy of disease –modifying anti-rheumatic agents: focus on the benefits and risks of etanercept. Drug Saf. 2002;25(3):173–97.

    Article  CAS  PubMed  Google Scholar 

  87. Beach data. Australian General Practice Statistics and Classification Centre: a collaborator unit of the Family Medicine Research Centre, University of Sydney and the Australian Institute of Health and Welfare, August 2006.

    Google Scholar 

  88. Ruderman EM. Overview of safety of non-biologic and biologic DMARDs. Rheumatology 2012SP(Suppl6)vi37-v143. https://doi.org/10.1093/rheumatology/kes283.

  89. NPS News (National Prescribing Service Letter). Helping patients achieve remission of rheumatoid arthritis.48,2006.

    Google Scholar 

  90. Olsen NJ, Stein CM. New drugs for rheumatoid arthritis. N Engl J Med. 2004;350:2167–79.

    Article  CAS  PubMed  Google Scholar 

  91. Cohen S, Cannon GW, Schiff M, Weaver A, Fox R, Olsen N, et al. Two-year, blinded, randomized controlled trial of treatment of active rheumatoid arthritis with leflunomide compared with methotrexate. Arthritis Rheum. 2001;44:1984–92.

    Article  CAS  PubMed  Google Scholar 

  92. O’Dell JR, Haire CE, Erikson N, Drymalski W, Palmer W, Eckhoff PJ, et al. Treatment of rheumatoid arthritis with methotrexate alone, sulfasalazine and hydroxychloroquine or combination of all three medications. N Engl JMed. 1996;334:1287–91.

    Article  Google Scholar 

  93. O’Shea JJ, Kontzias A,Yamaoka K, Kubo S, Nakano K, Iwata S, et al. Janus kinase inhibitors in autoimmune diseases. Ann Rheum Dis. 2013;72 Suppl 2:ii111–5.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Walker J, Smith M. Janus kinase inhibitors in rheumatoid arthritis. Aust Prescriber. 2014;37:158–160.

    Article  Google Scholar 

  95. Hughes SL, Dunlop D. The prevalence and impact of arthritis in older persons. Arthritis Rheum. 8:257–264. https://doi.org/10.1002/art.1790080409.

  96. Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh AK, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Arthritis Rheum. 2008;58(1):15–25.

    Article  PubMed  Google Scholar 

  97. Pollard L, Choy EH, Scott DL. The consequences of rheumatoid arthritis: quality of life measures in the individual patient. Clin Exp Rheumatol. 2005;23(5Suppl 39):S43–52.

    CAS  PubMed  Google Scholar 

  98. Sierakowska M, Krajewska-Kulak E, Sierakowski S. Quality of life in rheumatoid arthritis. Methods of measurement. Przegi Lek. 2005;62(3):188–91.

    Google Scholar 

  99. Lapsley HM, March LM, Tribe KL, Cross MJ, Courtenay BG, Brooks PM, for the Arthritis Cost and Outcome Project Group. Living with rheumatoid arthritis: expenditures, health status and social impact on patients. Ann Rheum Dis. 2002;61:818–821.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  100. Scott DL, Smith C, Kingsley G. What are the consequences of early rheumatoid arthritis for the individual? Best Pract Res Clin Rheumatol. 2005;19(1):117–36.

    Article  PubMed  Google Scholar 

  101. Strand V, Singh JA. Newer biological agents in rheumatoid arthritis: impact on health-related quality of life and productivity. Drugs. 2010;70(2):121–45.

    Article  CAS  PubMed  Google Scholar 

  102. Dominick K, Ahern FM, Gold CH, Heller DA. Health-related quality of life among older adults with arthritis. Health Qual Life Outcomes. 2004;2:5.

    Article  PubMed  PubMed Central  Google Scholar 

  103. Shanahan EM, Smith M, Roberts-Thomson L,Esterman A, Ahern M.. Influence of rheumatoid arthritis on work participation in Australia. Int Med J. 2008;38:166–173.

    Article  CAS  Google Scholar 

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Nagaratnam, N., Nagaratnam, K., Cheuk, G. (2018). Rheumatoid Arthritis. In: Geriatric Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-33434-9_60

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