Symptoms and Treatment Awareness for Arthritis in the Elderly
Rheumatoid Arthritis (RA) is a common autoimmune disease that affects millions worldwide. However, when it develops in older adults, known as Elderly Onset Rheumatoid Arthritis (EORA) or Late-Onset Rheumatoid Arthritis (LORA), it presents unique challenges and differences compared to the disease in younger individuals.
Differences Between EORA and Younger-Onset RA
EORA typically affects individuals aged 60 and above, in contrast to Younger-Onset RA (YORA) which usually occurs before the age of 60. The gender ratio in EORA is more balanced, with males and females being affected more evenly, unlike YORA where females predominate. EORA also tends to have a shorter disease duration at diagnosis due to its later onset.
The clinical features of EORA can sometimes mimic other age-related conditions like polymyalgia rheumatica or osteoarthritis, making diagnosis more challenging. Joint involvement may be more acute or atypical. Serum markers such as 14-3-3η protein are being investigated for diagnostic utility in EORA to distinguish it from other arthritis types in older adults.
Comorbidities are more common in EORA due to older age, which can complicate diagnosis and management.
Effect of EORA on Diagnosis
Diagnosing EORA can be challenging due to overlapping symptoms with age-related conditions. The presentation may be less classic, requiring careful clinical and serological evaluation. Serum markers such as 14-3-3η protein are emerging as useful diagnostic tools, and imaging and lab tests remain critical but must be interpreted in the context of age-related changes.
Effect on Treatment
The treatment approach for EORA is broadly similar to younger patients, using Disease-Modifying Antirheumatic Drugs (DMARDs) to suppress immune system activity and minimize joint damage. However, considerations in older adults include comorbid conditions, polypharmacy, and altered drug metabolism, which require careful drug choice and dosage adjustments. Physical therapy and lifestyle modifications remain essential but may be tailored to older adults’ physical capacity and comorbidities. Treatment may need closer monitoring to balance efficacy and potential adverse effects.
Effect on Prognosis
The prognosis in EORA can be different due to the shorter disease duration, fewer accumulated joint damages initially, but comorbidities and overall health status impact long-term outcomes significantly. Younger-onset RA generally has a longer course and potentially more severe joint destruction due to longer disease duration, while EORA may progress differently and often moderately but with greater risks linked to age. EORA affects physical, psychological, and social health and may contribute more to disability given the age and comorbidities.
In summary, EORA differs mainly by later age of onset, distinct clinical and serologic profiles, and greater challenges in diagnosis due to overlap with other age-associated conditions. Treatment must be individualized with vigilant monitoring, and prognosis depends more on overall health and comorbidities, while the natural history of the disease might be less severe in terms of joint destruction compared to RA in younger patients.
Attending RA management classes can help people learn how to manage and control their symptoms and improve their quality of life. The Centers for Disease Control and Prevention (CDC) lists self-management programs on its website. Older adults can also manage EORA symptoms through staying physically active, resting affected joints, stopping smoking, maintaining a moderate weight, getting adequate sleep, adjusting the home environment, and treating comorbidities.
Tobacco smoke can make it more challenging to stay physically active and manage RA symptoms. Other symptoms of Rheumatoid Arthritis may include unintentional weight loss, fatigue, weakness, and fever. It's essential to note that about 1.9 million people in the United States have Rheumatoid Arthritis.
In older adults, the presence of rheumatoid factor (RF) in the blood does not always indicate an autoimmune disease, with about 10% of healthy people aged 60 years and over having RF in their blood. A single-center 2020 study found that treating conditions such as diabetes or interstitial lung disease had a positive effect on older adults with RA.
Early diagnosis of EORA leads to a better outlook, and anyone with symptoms that could indicate Rheumatoid Arthritis should speak with a doctor as soon as they can. The signs that may indicate Rheumatoid Arthritis include pain, aching, tenderness, swelling, or stiffness in more than one joint. About 50-75% of EORA cases occur with other conditions, or comorbidities. A 2017 study found that only 18.5% of participants with RA had good sleep.
Treatment for EORA includes short-term use of prednisone for inflammation reduction, nonsteroidal anti-inflammatory drugs (NSAIDs), immunosuppressant drugs, and disease-modifying antirheumatic drugs such as sulfasalazine, leflunomide, and methotrexate.
References:
- Rheumatoid Arthritis in Older Adults
- Late-Onset Rheumatoid Arthritis: An Overview of Current Knowledge
- Prevalence and Comorbidity of Rheumatoid Arthritis in Older Adults: A Systematic Review and Meta-Analysis
- Sex Differences in Rheumatoid Arthritis: A Systematic Review
- Late-Onset Rheumatoid Arthritis
- Aging and longevity have significant implications for the onset and progression of Rheumatoid Arthritis (RA), with the disease known as Elderly Onset Rheumatoid Arthritis (EORA) or Late-Onset Rheumatoid Arthritis (LORA) affecting individuals aged 60 and above.
- The clinical features of EORA can sometimes resemble other medical conditions associated with aging, such as polymyalgia rheumatica or osteoarthritis, making diagnosis challenging.
- In the case of EORA, chronic diseases like chronic kidney disease, skin care issues, and overall health and wellness in both men's health and women's health become increasingly relevant, as the older population is more likely to have numerous chronic health conditions.
- Medical-conditions like diabetes, interstitial lung disease, and other chronic diseases can impact the treatment and prognosis of EORA in older adults, making it crucial to address these factors during treatment planning.
- Early diagnosis of EORA can lead to a better outlook, as symptoms, such as pain, aching, stiffness, or swelling in multiple joints, may indicate Rheumatoid Arthritis.
- Science continues to uncover new diagnostic tools for EORA, with serum markers like the 14-3-3η protein showing promise in distinguishing EORA from other arthritis types in older adults.
