Document Detail


Management issues with elderly-onset rheumatoid arthritis: an update.
MedLine Citation:
PMID:  16245956     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Elderly-onset rheumatoid arthritis (EORA) is defined as rheumatoid arthritis (RA) starting at >60 years of age. EORA is characterised by a lower female/male ratio compared with RA in younger patients and it more frequently has an acute onset accompanied by constitutional symptoms. Two incompletely overlapping subsets of RA have been recognised: one exhibits the classical RA clinical picture while the other has a polymyalgia rheumatica-like appearance, characterised by shoulder involvement, absence of rheumatoid factor and, usually, by a nonerosive course. Identification of anti-cyclic citrullinated peptide antibodies is useful for distinguishing the latter subset from true polymyalgia rheumatica. Elderly-onset spondyloarthritis, crystal-related arthritis, remitting seronegative symmetrical synovitis with pitting oedema syndrome and hepatitis C virus-related arthritis must also be considered in the differential diagnosis. EORA treatment requires prudence because of the increase in age-related risks pertaining principally to the renal, cardiovascular and gastrointestinal systems. No groups of molecules usually employed for RA therapy in younger subjects (analgesics, NSAIDs, corticosteroids, disease-modifying antirheumatic drugs, anticytokine drugs) can be excluded a priori from the treatment of EORA patients. Nevertheless, the risk/benefit ratio relating to their use must be accurately evaluated for every single patient. Recently marketed compounds such as leflunomide and tumour necrosis factor-alpha antagonists have also increased the therapeutic opportunities for aged RA patients.
Authors:
Ignazio Olivieri; Carlo Palazzi; Giovanni Peruz; Angela Padula
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Drugs & aging     Volume:  22     ISSN:  1170-229X     ISO Abbreviation:  Drugs Aging     Publication Date:  2005  
Date Detail:
Created Date:  2005-10-25     Completed Date:  2006-01-20     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9102074     Medline TA:  Drugs Aging     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  809-22     Citation Subset:  IM    
Affiliation:
Rheumatology Department of Lucania, Matera and Potenza: S. Carlo Hospital of Potenza, Chieti, Italy. ignazioolivieri@tiscalinet.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Aging* / drug effects
Antirheumatic Agents / administration & dosage,  adverse effects,  therapeutic use*
Arthritis, Rheumatoid* / diagnosis,  drug therapy,  epidemiology
Diagnosis, Differential
Humans
Chemical
Reg. No./Substance:
0/Antirheumatic Agents

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