Articular Syndrome in the Elderly: Common Differentials and Challenges

Abstract

Articular syndrome includes a spectrum of inflammatory and non-inflammatory joint involvement ranging from arthralgia to arthritis. Its phenotype, differentials and management differ slightly in the elderly, considering the added effect of physiological changes with ageing, comorbidity and multimorbidity. This review aims to provide an overview of the common differentials of articular syndrome in the elderly, including the inflammatory and degenerative causes. The common inflammatory arthritis in the elderly includes late-onset rheumatoid arthritis, polymyalgia rheumatica, paraneoplastic arthritis, crystal arthropathies, and systemic vasculitis, including ANCA-associated vasculitis, to name a few. The non-inflammatory articular syndromes in this age group predominantly include osteoarthritis and osteoporosis. There are also evident alterations in the gut microbiome associated with inflammatory arthritis and with physiological ageing and osteoarthritis, which have possible mechanistic significance. The management aspect in the geriatric population comes with challenges of addressing multimorbidity, polypharmacy, drug interactions, and not just disease activity. An integrated approach with effective physical therapy, and vocational activities, tailored to each patient is essential for optimal management.