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rheumatoid arthritis in the elderly
Etiology:
1) infection
2) malignancy
3) idiopathic
Epidemiology:
1) more* equal sex distribution
2) 23-30% of patients present > 60 years of age
Pathology:
- closely linked with polymyalgia rheumatica in the elderly
Clinical manifestations:
1) higher* frequency of abrupt onset
2) more* large joint complaints
3) less* extra-articular disease
4) longer* morning stiffness
5) less often* have rheumatoid nodules
6) fewer* symptoms
Laboratory:
1) higher* erythrocyte sedimentation rate (ESR)
2) 50% rheumatoid factor (RF) positive
Differential diagnosis:
- closely linked with polymyalgia rheumatica in the elderly
Management:
1) see rheumatoid arthritis
2) pharmaceutical agents
-> methotrexate is drug of choice in the elderly [2]
3) prognosis
a) heterogenous group with favorable functional prognosis
b) subgroup of women with functional disability at onset has worse outcome
c) positive rheumatoid factor & symmetrical polyarthritis has increased mortality compared to seronegative group
* in comparison to younger patients
General
rheumatologic disorders in the elderly
rheumatoid arthritis (RA)
References
- Weiner S, In: UCLA Intensive Course in Geriatric Medicine
& Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- Geriatrics Review Syllabus, American Geriatrics Society,
5th edition, 2002-2004