rheumatoid arthritis in the elderly
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Etiology
- infection
- malignancy
- idiopathic
Epidemiology
- more* equal sex distribution
- 23-30% of patients present > 60 years of age
Pathology
- closely linked with polymyalgia rheumatica in the elderly
Clinical manifestations
- higher* frequency of abrupt onset
- more* large joint complaints
- less* extra-articular disease
- longer* morning stiffness
- less often* have rheumatoid nodules
- fewer* symptoms
Laboratory
- higher* erythrocyte sedimentation rate (ESR)
- 50% rheumatoid factor (RF) positive
Differential diagnosis
- closely linked with polymyalgia rheumatica in the elderly
Management
- see rheumatoid arthritis
- pharmaceutical agents
- methotrexate is drug of choice in the elderly[2]
- prognosis
- heterogenous group with favorable functional prognosis
- subgroup of women with functional disability at onset has worse outcome
- positive rheumatoid factor & symmetrical polyarthritis has increased mortality compared to seronegative group
* in comparison to younger patients