Elderly-Onset Rheumatoid Arthritis: Characteristics and Treatment Options

Abstract

Elderly-onset rheumatoid arthritis (EORA) is a distinct clinical entity defined as the onset of rheumatoid arthritis (RA) in individuals aged over 60 years. EORA presents unique clinical features, including a more equitable distribution of sexes, a potential predilection for male involvement, a higher incidence of acute onset characterized by constitutional symptoms, a propensity for systemic manifestations, elevated sedimentation rates at disease onset, a reduced occurrence of rheumatoid factor positivity, increased titers of anti-citrullinated protein antibodies, a preference for involvement of large joints, elevated disease activity, the presence of bone erosions, and heightened patient disability. RA is recognized to consist of three partially overlapping subsets. One subset mirrors the classical RA clinical presentation, while the remaining subsets exhibit either a polymyalgia rheumatica-like phenotype or present with remitting seronegative symmetrical synovitis accompanied by pitting edema syndrome. In the initial stages of EORA management, non-steroidal anti-inflammatory drugs (NSAIDs) are not typically the first-line treatment choice, because seniors are much more prone to develop side effects due to NSAIDs, and the use of NSAIDs is in reality contraindicated to the majority of seniors due to comorbidities. Disease-modifying antirheumatic drugs (DMARDs), frequently methotrexate, are introduced immediately after the diagnosis is made. In cases where elderly patients demonstrate resistance to conventional DMARD therapy, the introduction of biological or targeted synthetic DMARDs becomes a viable treatment option. EORA presents a unique clinical profile, necessitating tailored treatment strategies. Our study emphasizes the challenges of NSAID use in seniors, highlighting the imperative shift toward DMARDs such as methotrexate. Future research should explore personalized DMARD approaches based on disease activity, comorbidities, and safety considerations, aiming to optimize treatment outcomes and minimize glucocorticoid reliance, thereby enhancing the quality of care for EORA patients.

Safety of Tocilizumab on Rheumatoid Arthritis in Patients with Interstitial Lung Disease

“…Also, the male to female ratio was 1:2.6 in the period 2010–2011, 26 and elderly-onset RA shows a male predilection. 27 Considering the current trend in age of onset and the male to female ratio, the patients in this study seem to reflect the RA population in Japan.…”

Seronegative Rheumatoid Arthritis in an Elderly Dialysis Patient With Multiple Comorbidities: A Case Report

“…Steroids like PSL play a crucial role in treating many autoimmune diseases due to their potent anti-inflammatory effects, as evidenced by symptom remission and improved quality of life in this patient [ 12 ]. However, the use of steroid treatment also carries the risk of side effects such as osteoporosis, diabetes, and increased infection risk, necessitating a careful evaluation of the benefits and risks of treatment [ 13 ].…”

A Case of Painless Elderly-Onset Rheumatoid Arthritis

“…Our case displayed many of the typical features of EORA. Clinically, EORA has a tendency to present more acutely with prominent weight loss and lethargy compared to younger-onset RA [ 6 ]. On laboratory tests, EORA patients generally have higher CCP antibody titers as well as high CRP, WCC, and erythrocyte sedimentation rate (ESR) levels as was seen in this case [ 7 ].…”

“…Elderly-onset rheumatoid arthritis (EORA) is commonly defined as RA with an onset in patients over the age of 60 years. EORA patients are more likely to present with systemic features and higher inflammatory marker levels, resembling infection even more so than RA in younger patients [ 6 ]. Nevertheless, joint pain and swelling are prominent features in the majority of EORA patients [ 7 ].…”