Specific clinical features of late-onset rheumatoid arthritis
Authors:
MUDr. Jan Klán 1; MUDr. Hana Ciferská; Ph.D. 2; Prof. MUDr. Eva Topinková, CSc. 1
Authors‘ workplace:
Geriatrická klinika 1. LF UK a VFN, Praha
1; Revmatologický ústav, Praha
2
Published in:
Geriatrie a Gerontologie 2014, 3, č. 1: 18-24
Category:
Review Article
Overview
Diseases of the musculoskeletal system are one of the most common causes of disability in elderly patients. In this article we discuss clinical features of late onset rheumatoid arthritis (LORA), which is defined as having developed past the age of 65 years. LORA can be often misdiagnosed due to differential diagnosis problems characteristic for the elderly. LORA often has different clinical manifestation in comparison to classic cases of rheumatoid arthritis. The new diagnostic approaches and new drugs were introduced during the last decade. The main goal of treatment is to achieve remission and to prevent irreversible joint damage by timely and effective therapy. The disease modifying anti-rheumatic drugs (DMARD) are the baseline therapy of rheumatoid arthritis, however new biological drugs that appeared throughout the last decade are increasingly being used, especially in patients with severe forms of rheumatoid arthritis, with history of DMARD failure.
Key words:
rheumatoid arthritis – old age – LORA – disability – DMARD – biological therapy
Sources
1. Mann H: Revmatoidní artritida. Interní medicína pro praxi 2012; 14 (4): 177–181.
2. Vencovský J: Revmatoidní artritida ve vyšším věku. Postgraduální medicína 2004; 6: 73–77.
3. Shanmuganandan LCK, Arunachalam CR: Late onset rheumatoid arthritis. Indian Journal of Rheumatology 2009; (6), Volume 4, Number 2; 56–60.
4. Bajocchi G, La Corte R, Locaputo A et al.: Elderly onset rheumatoid arthritis – clinical aspects. Clin Exp Rheumatol 2000; 18(4 Suppl. 20); 49–50.
5. Huscher D, Sengler C, Ziegler S, Gromnica-Ihle E; komentář Šenolt L: Revmatoidní artritida ve stáří. Medicína po promoci 2009; 6: 28–34.
6. Alušík Š: Revmatologie. Triton 2002. str. 20–28.
7. Pavelka K: Některé aspekty gerontorevmatologie. Česká geriatrická revue 2004; 4: 5–14.
8. Turkcapar N, Demir O, Atli T et al.: Late onset rheumatoid arthritis: clinical and laboratory comparisons with younger onset patients. Arch Gerontol Geriatr 2006; 42: 225–231
9. Hrba J: Revmatoidní artritida. Doporučené postupy pro praktické lékaře ČLS JEP, 2002. Projekt MZ ČR zpracovaný ČLS JEP za podpory grantu IGA MZ ČR 5390–3.
10. Topinková E: Geriatrie pro praxi. Galén 2005. str. 167–184.
11. Lopez-Hoyos M, de Ruiz Alegria C, Blanco R et al: Clinical utility of anti-CPP antibodies in the differential diagnosis of elderly-onset rheumatoid arthritis and polymyalgia rheumatica. Rheumatology (Oxford) 2004; 43: 655–657.
12. Gatterová J, Seidl Z, Vaněčková M et al.: Skórovací systémy při hodnocení progrese revmatoidní artritidy. Čes Revmatol 2008; 16(2): 89–91.
13. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT et al.: 2010 Rheumatoid Arthritis Classification Criteria An American College of Rheumatology / European League Against Rheumatism Collaborative Initiative. Ann Rheum Dis 2010; 69: 1580–1588.
14. Smolen J, Breedveld FC, Schiff MH et al.: A simplified disease activity index for rheumatoid arthritis for use in clinical practise. Rheumatology (Oxford) 2003; 42: 244–257.
15. Topinková E: Muskuloskeletální a revmatická onemocnění ve stáří. Postgraduální medicína 2004; 6: 57–65.
16. Pease CT, Haugeberg G, Montague B et al.: Polymyalgia rheumatica can be distinguished from late onset rheumatoid arthritis at baseline: results of a 5-yr prospective study. Rheumatology (Oxford) 2009; 48: 123–127.
17. Pavelka K, Vencovský J: Doporučení České revmatologické společnosti pro léčbu revmatoidní artritidy. Čes Revmatol 2010; 18(4), 182–191.
18. Smolen JS, Landewe R, Breedveld FC et al.: EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis 2010; 69: 964–975.
19. Tutuncu Z, Reed G, Kremer J, Kavanaugh A: Do patients with older-onset rheumatoid arthritis receive less aggressive treatment? Ann Rheum Dis 2006; 65: 1226–1229.
20. Fialová D, Topinková E: Specifické rysy geriatrické farmakoterapie z pohledu farmakokinetických a farmakodynamických změn ve stáří. Remedia 2002; 12: 434–440.
21. Visser K, Katchmart W, Loza E et al.: Multinational evidence based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E initiative. Ann Rheum Dis 2009; 68: 1086–1093.
22. Visser K, van der Heijde D.: Optimal dosage and route of administration of methotrexate in rheumatoid arthritis: a systematic review of the literature. Ann Rheum Dis 2009; 68: 1094–1099.
23. Strand V, Cohen S, Schiff M et al.: Treatment of active rheumatoid arthritis with leflunomide compared with placebo and methotrexate. Arch Intern Med 1999; 159: 242–255.
24. Smolen JS, Kalden J, Scott DL et al.: Efficacy and safety of leflunomide compared with placebo and sulphasalazine in active rheumatoid arthritis: a double blind, randomized, multicenter study. Lancet 1999; 353: 259–266.
25. Šedová L, Štolfa J, Horák P, Pavelka K: Doporučení České revmatologické společnosti pro monitorování bezpečnosti léčby revmatoidní artritidy. Čes Revmatol 2009; 17(1): 4–15.
26. Vencovský J a výbor České revmatologické společnosti: Bezpečnost biologické léčby – doporučení České revmatologické společnosti. Čes Revmatol 2009; 17(3): 146–160.
27. Sidiropoulos P, Flouri ID, Drosos A: Geriatric patients receiving anti-TNFA agents have comparable to younger adults response but increased incidence of serious adverse events. Ann Rheum Dis 2008; 67 (Suppl II): 180.
28. Kirwan JR: The effect of glucocorticoids in joint destruction in rheumatoid arthritis, N Engl J Med 1995; 333: 142–146.
Labels
Geriatrics General practitioner for adults Orthopaedic prostheticsArticle was published in
Geriatrics and Gerontology
![Issue 1](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/abce030152bc057be8eacbe07398a2c1.jpeg)
2014 Issue 1
Most read in this issue
- The issue of arterial hypertension in questions and answers
- Prevention and management of instability and falls in geriatric patients
- Specific clinical features of late-onset rheumatoid arthritis
- Home-based care for patients with dementia in the context of burden on non-expert/non-professional caregivers