Via practica 1/2008

CLINICAL PICTURE AND COURSE OF ELDERLY-ONSET RHEUMATOID ARTHRITIS

Elderly-onset rheumatoid arthritis (EORA) represents some clinical and genetic variations from rheumatoid arthritis (RA) with rapid onset. Basic differences in EORA are: 1. approximately equal occurrence of the disease in women and men, 2. the onset of the disease is more frequently acute, 3. more frequent involvement of large joints, 4. more frequent oligo-articular distribution, 5. more frequent systemic manifestations at the beginning – high erythrocyte sedimentation, weight loss, or fatigue, 6. more frequent occurrence of „RF serum negativity, 7. worse functional ability and decreased quality of life in EORA patients. Slightly more cases with severe course, where grave functional involvement and destructive changes develop rapidly. Other rheumatic diseases, which occur in the elderly, as polymyalgia rheumatica, remitting seronegative symmetrical synovitis with soft edema syndrome at the dorsum of hands and feet, gouty arthritis, Calcium pyrophosphate arthropathy, osteoarthritis, paraneoplastic syndromes and other nosological entities (spondylarthritis in elderly) shall be considered in differential diagnostics. In therapy procedures the account shall be taken of the fact that the elderly usually suffer from more than one disease and are administered several various drugs which might interact.

Keywords: rheumatoid arthritis in the elderly, pathogenesis, clinical picture, differential diagnostics, treatment course, therapy principles.