Drugs & Aging

, Volume 22, Issue 10, pp 809–822 | Cite as

Management Issues with Elderly-Onset Rheumatoid Arthritis

An Update
  • Ignazio Olivieri
  • Carlo Palazzi
  • Giovanni Peruz
  • Angela Padula
Leading Article


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-α antagonists have also increased the therapeutic opportunities for aged RA patients.


Rheumatoid Arthritis Rheumatoid Arthritis Patient Sulfasalazine Leflunomide Hydroxychloroquine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by a grant from the Government of Basilicata (Lucania) Region.

The authors have no conflicts of interest that are directly relevant to the content of this review.


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Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  • Ignazio Olivieri
    • 1
  • Carlo Palazzi
    • 1
  • Giovanni Peruz
    • 1
  • Angela Padula
    • 1
  1. 1.Rheumatology Department of LucaniaMatera and Potenza: S. Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, and the Rheumatology Division of the ‘Villa Pini’ ClinicChietiItaly

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