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Review

Elderly-Onset Rheumatoid Arthritis: Characteristics and Treatment Options

by
Slavica Pavlov-Dolijanovic
1,*,
Milan Bogojevic
2,
Tatjana Nozica-Radulovic
3,
Goran Radunovic
1 and
Natasa Mujovic
4
1
University of Belgrade, Faculty of Medicine, Institute of Rheumatology, 11000 Belgrade, Serbia
2
Clinical Centre of Montenegro, Department of Rheumatology, 81000 Podgorica, Montenegro
3
Faculty of Medicine, Institute for Physical Medicine and Rehabilitation and Orthopedic Surgery “Dr. Miroslav Zotovic”, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
4
University of Belgrade, Faculty of Medicine, Center for Physical Medicine and Rehabilitation, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
*
Author to whom correspondence should be addressed.
Medicina 2023, 59(10), 1878; https://doi.org/10.3390/medicina59101878
Submission received: 30 August 2023 / Revised: 1 October 2023 / Accepted: 18 October 2023 / Published: 23 October 2023
(This article belongs to the Section Geriatrics/Aging)

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.
Keywords: elderly-onset rheumatoid arthritis; rheumatoid arthritis; prognosis; treatment elderly-onset rheumatoid arthritis; rheumatoid arthritis; prognosis; treatment

Share and Cite

MDPI and ACS Style

Pavlov-Dolijanovic, S.; Bogojevic, M.; Nozica-Radulovic, T.; Radunovic, G.; Mujovic, N. Elderly-Onset Rheumatoid Arthritis: Characteristics and Treatment Options. Medicina 2023, 59, 1878. https://doi.org/10.3390/medicina59101878

AMA Style

Pavlov-Dolijanovic S, Bogojevic M, Nozica-Radulovic T, Radunovic G, Mujovic N. Elderly-Onset Rheumatoid Arthritis: Characteristics and Treatment Options. Medicina. 2023; 59(10):1878. https://doi.org/10.3390/medicina59101878

Chicago/Turabian Style

Pavlov-Dolijanovic, Slavica, Milan Bogojevic, Tatjana Nozica-Radulovic, Goran Radunovic, and Natasa Mujovic. 2023. "Elderly-Onset Rheumatoid Arthritis: Characteristics and Treatment Options" Medicina 59, no. 10: 1878. https://doi.org/10.3390/medicina59101878

APA Style

Pavlov-Dolijanovic, S., Bogojevic, M., Nozica-Radulovic, T., Radunovic, G., & Mujovic, N. (2023). Elderly-Onset Rheumatoid Arthritis: Characteristics and Treatment Options. Medicina, 59(10), 1878. https://doi.org/10.3390/medicina59101878

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