Rheumatologic Diseases

  • Leif B. Sorensen
  • Joy M. Blair


By all demographic projections, the population 65 years of age and older will increase rapidly in absolute and relative numbers through the year 2020 and beyond. Although the majority of older individuals in the future will be healthy and able to function independently, a significant fraction will develop chronic health problems varying in degree from relatively minor difficulties to severe disabilities. Chronic diseases, such as arthritis, will contribute prominently to disability. In a survey conducted in 1989 by the National Center for Health Statistics,1 the leading chronic conditions in the elderly were arthritis, hypertension, hearing impairment, and heart disease. Arthritis ranked first among the 10 most prevalent chronic health problems, with a prevalence of 483 per 1,000 individuals 65 years and older and 554 per 1,000 individuals age 75 and above. Estimates of arthritis prevalence and physical activity limitation were derived from household interview data from the 1989–1991 National Health Interview Survey and applied to the 1990 census population.2 An estimated 37.9 million people, 15% of the total United States population, had arthritis in 1990. The estimated prevalence rate was 49.4% for people aged 65 years and over, as compared with 5.1% for people aged 44 years and under, and 0.5% for children aged 16 or under. In 1990, 7 million people (2.8% of the total U.S. population) were estimated to have activity limitation due to arthritis. Activity limitation associated with arthritis in the 65+ age group was estimated at 11.6%.


Rheumatoid Arthritis Synovial Fluid Carpal Tunnel Syndrome Giant Cell Arteritis Keratan Sulfate 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    National Center for Health Statistics. Current estimates from the National Health Interview Survey, 1989. Vital and Health Statistics, Series 10, No. 176. October, 1990.Google Scholar
  2. 2.
    Center for Disease Control. Arthritis prevalence and activity limitations-United States, 1990. MMWR. 1994; 43: 433438.Google Scholar
  3. 3.
    Felson DT, Naimark A, Anderson J, et al. The prevalence of knee osteoarthritis in the elderly: the Framingham Osteoarthritis Study. Arthritis Rheum. 1987; 30: 914–918.PubMedCrossRefGoogle Scholar
  4. 4.
    Felson DT. The epidemiology of knee osteoarthritis: results from the Framingham study. Semin Arthritis Rheum. 1990; 20: 42–50.PubMedCrossRefGoogle Scholar
  5. 5.
    Davis MA, Ettinger WH, Neuhaus JM. Obesity and osteoarthritis of the knee: evidence from the National Health and Nutrition Examination Survey (NHANES I). Semin Arthritis Rheum. 1990; 20: 34–41.PubMedCrossRefGoogle Scholar
  6. 6.
    Hardingham TE, Muir H, Maini RN. Research in arthritis. Br J Rheum. 1991; 30 (suppl. 1): 1–89.CrossRefGoogle Scholar
  7. 7.
    Cuevas P, Burgos J, Baird A. Basic fibroblast growth factor (FGF) promotes cartilage repair in vivo. Biochem Biophys Res Commun. 1988; 156: 611–618.PubMedCrossRefGoogle Scholar
  8. 8.
    Knowlton RG, Katzenstein PL, Moskowitz RW, et al. Genetic linkage of a polymorphism in the type II procollagen gene (COL2A1) to primary osteoarthritis associated with mild chondrodysplasia. N Engl J Med. 1990; 322: 526–530.PubMedCrossRefGoogle Scholar
  9. 9.
    Ala-Kokko L, Baldwin CT, Moskowitz RW, et al. Single base mutation in the type II protocollagen gene (COL2A1) as a cause of primary osteoarthritis associated with mild chondrodysplasia. Proc Natl Acad Sci USA. 1990; 87: 65656568.Google Scholar
  10. 10.
    Felson DT, Anderson JJ, Naimark A. Obesity and knee osteoarthritis. Ann Intern Med. 1988; 109: 18–24.PubMedGoogle Scholar
  11. 11.
    Felson DT, Zhang Y, Anthony JM, et al. Weight loss reduces the risk of symptomatic knee osteoarthritis in women. Ann Intern Med. 1992; 116: 535–539.PubMedGoogle Scholar
  12. 12.
    Kohatsu ND, Shurman DJ. Risk factors for the development of osteoarthrosis of the knee. Clin Orthop. 1990; 261: 242–246.PubMedGoogle Scholar
  13. 13.
    Vetto AA, Mannik M, Zatarain-Rios E, et al. Immune deposits in articular cartilage of patients with rheumatoid arthritis have a granular pattern not seen in osteoarthritis. Rheumatol Int. 1990; 10: 13–20.PubMedCrossRefGoogle Scholar
  14. 14.
    Hall S, Bartleson JD, Onofrio BM, et al. Lumbar spinal stenosis: clinical features, diagnostic procedures, and results of surgical treatment in 68 patients. Ann Intern Med. 1985; 103: 271–275.PubMedGoogle Scholar
  15. 15.
    Mehraban F, Finegan CK, Moskowitz RW. Serum keratan sulphate: quantitative and qualitative comparisons in inflammatory versus noninflammatory arthritides. Arthritis Rheum. 1991; 34: 383–392.PubMedCrossRefGoogle Scholar
  16. 16.
    Fife RS, Brandt KD, Braunstein EM, et al. Relationship between arthroscopic evidence of cartilage damage and radiographic evidence of joint space narrowing in early osteoarthritis of the knee. Arthritis Rheum. 1991; 34: 377382.Google Scholar
  17. 17.
    Hult L. Cervical, dorsal and lumbar spinal syndromes. A field investigation of a non-selected material of 1200 workers in different occupations with special reference to disc degeneration and so-called muscular rheumatism. Acta Orthop Scand. 1954;(suppl)17:1–102.Google Scholar
  18. 18.
    Houpt JB, Pritzker KPH, Alpert B, et al. Natural history of spontaneous osteonecrosis of the knee (SONK): a review. Semin Arthritis Rheum. 1983; 13: 212–227.PubMedCrossRefGoogle Scholar
  19. 19.
    Minor MA, Hewett JE, Webel RR, et al. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis Rheum. 1989; 32: 1396–1405.PubMedCrossRefGoogle Scholar
  20. 20.
    Gerber L. Exercise and arthritis. Bull Rheum Dis. 1990; 39: 1–9.PubMedGoogle Scholar
  21. 21.
    Kovar PA, Allegrante JP, Mac Kenzie CR, et al. Supervised fitness walking in patients with osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med. 1992; 116: 529–533.PubMedGoogle Scholar
  22. 22.
    Ike RW, Arnold WJ, Rothschild EW, et al. Tidal irrigation versus conservative medical management of patients with osteoarthritis of the knee. J Rheumatol. 1992; 19: 772–779.PubMedGoogle Scholar
  23. 23.
    Bradley JD, Brandt KD, Katz BP, et al. Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee. N Engl J Med. 1991; 325: 8791.CrossRefGoogle Scholar
  24. 24.
    Bradley JD, Brandt KD, Katz BP, et al. Treatment of knee osteoarthritis: relationship of clinical features of joint inflammation to the response to a nonsteroidal antiinflammatory drug or pure analgesic. J Rheumatol. 1992; 19: 1950–1954.PubMedGoogle Scholar
  25. 25.
    Deal CL, Schnitzer TJ, Lipstein E. Treatment of arthritis with topical capsaicin: a double-blind trial. Clin Ther. 1991; 13: 383–395.PubMedGoogle Scholar
  26. 26.
    Altman RD, Dean DD, Muniz 0E, et al. Therapeutic treatment of canine osteoarthritis with glycosaminoglycan polysulfuric acid ester. Arthritis Rheum. 1989; 32: 1300–1307.PubMedCrossRefGoogle Scholar
  27. 27.
    Moskowitz RW, Reese JH, Young RG, et al. The effects of Rumalon, a glycosaminoglycan peptide complex, in a partial meniscectomy model of osteoarthritis in rabbits. J Rheumatol. 1991; 18: 205–209.PubMedGoogle Scholar
  28. 28.
    Hollingworth P, Scott JT, Burry HC. Nonarticular gout: hyperuricemia and tophus formation without gouty arthritis. Arthritis Rheum. 1983; 26: 98–101.PubMedCrossRefGoogle Scholar
  29. 29.
    Wernick R, Winkler C, Campbell S. Tophi as the initial manifestation of gout: report of six cases and review of the literature. Arch Intern Med. 1992; 152: 873–876.PubMedCrossRefGoogle Scholar
  30. 30.
    Ellman MH, Brown ML, Levin B. Prevalence of knee chondrocalcinosis in hospital and clinic patients aged 50 or older. J Am Geriatr Soc. 1981; 29: 189–192.Google Scholar
  31. 31.
    Bergstrom G, Bjelle A, Sorensen LB, et al. Prevalence of rheumatoid arthritis, osteoarthritis, chondrocalcinosis and gouty arthritis at age 79. J Rheumatol. 1986; 13: 527534.Google Scholar
  32. 32.
    Menkes CJ, Simon F, Delrieu F, et al. Destructive arthropathy in chondrocalcinosis. Arthritis Rheum. 1976; I9 (suppl): 329–348.CrossRefGoogle Scholar
  33. 33.
    Carroll GJ, Stuart RA, Armstrong JA, et al. Hydroxyapatite crystals are a frequent finding in osteoarthritic synovial fluid, but are not related to increased concentrations of keratan sulfate or interleukin 1(3. J Rheumatol. 1991; 18: 86 1866.Google Scholar
  34. 34.
    McCarty DJ, Halverson PB, Carrera GF, et al. Milwaukee shoulder association of microspheroids containing hydroxyapatite crystals, active collagenase and neutral protease with rotator cuff defects. I. Clinical aspects. Arthritis Rheum. 1981; 24: 464–473.PubMedCrossRefGoogle Scholar
  35. 35.
    Hunder GG, Hazleman BL. Giant cell arteritis and polymyalgia rheumatica. In: Kelley WN, Harris ED, Ruddy S, Sledge CB, eds. Textbook of Rheumatology. Philadelphia: WB Saunders; 1985: 1166–1173.Google Scholar
  36. 36.
    Chuang T-Y, Hunder GG, Ilstrup DM, et al. Polymyalgia rheumatica: a 10-year epidemiologic and clinical study. Ann Intern Med. 1982;97:672–680.Google Scholar
  37. 37.
    Machado EB, Michet CJ, Ballard DJ, et al. Trends in incidence and clinical presentation of temporal arteritis in Olmsted County, Minnesota, 1950–1985. Arthritis Rheum. 1988; 31: 745–749.PubMedCrossRefGoogle Scholar
  38. 38.
    Boesen P, Sorensen SF. Giant cell arteritis, temporal arteritis, and polymyalgia rheumatica in a Danish county: a prospective investigation, 1982–1985. Arthritis Rheum. 1987; 30: 294–299.PubMedCrossRefGoogle Scholar
  39. 39.
    Östberg G. On arteritis with special reference to polymyalgia arteritica. Acta Pathol Microbiol Scand. 1973; 237 (suppl A): 1–59.Google Scholar
  40. 40.
    Andersson R, Jonsson R, Tarkowski A, et al. T cell subsets and expression of immunological activation markers in the arterial walls of patients with giant cell arteritis. Ann Rheum Dis. 1987; 46: 915–923.PubMedCrossRefGoogle Scholar
  41. 41.
    Liang GC, Simkin PA, Mannik M. Immunoglobulins in temporal arteritis. An immunofluorescent study. Arthritis Rheum. 1974; 81: 19–24.CrossRefGoogle Scholar
  42. 42.
    Richardson JE, Gladman DD, Fam A, et al. HLA-DR4 in giant cell arteritis: association with polymyalgia rheumatica syndrome. Arthritis Rheum. 1987;30:1293–1297.Google Scholar
  43. 43.
    Cid M-C, Ercilla G, Vilaseca J, et al. Polymyalgia rheumatica: a syndrome associated with HLA-DR4 antigen. Arthritis Rheum. 1988; 31: 678–682.PubMedCrossRefGoogle Scholar
  44. 44.
    Gonzalez EB, Varner WT, Lisse JR, et al. Giant cell arteritis in the Southern United States. An 11-year retrospective study from the Texas Gulf Coast. Arch Intern Med. 1989; 149: 1561–1565.PubMedCrossRefGoogle Scholar
  45. 45.
    Caselli RJ, Hunder GG, Whisnant JP. Neurologic disease in biopsy-proven giant cell (temporal) arteritis. Neurology. 1988; 38: 352–359.PubMedCrossRefGoogle Scholar
  46. 46.
    Calamia KT, Hunder GG. Giant cell arteritis (temporal arteritis) presenting as fever of undetermined origin. Arthritis Rheum. 1981; 24: 1414–1418.PubMedCrossRefGoogle Scholar
  47. 47.
    ve-Söderbergh J, Malmvall B-E, Andersson R, et al. Giant cell arteritis as a cause of death: report of nine cases. JAMA. 1986;255:493–496.Google Scholar
  48. 48.
    Nordborg E, Bengtsson, BA. Death rates and causes of deaths in 284 consecutive patients with giant cell arteritis confirmed by biopsy. Br Med J. 1989; 299: 549–550.CrossRefGoogle Scholar
  49. 49.
    Wise CM, Agudelo CA, Chmelewski WL, et al. Temporal arteritis with low erythrocyte sedimentation rate: a review of five cases. Arthritis Rheum. 1991; 34: 1571–1574.PubMedCrossRefGoogle Scholar
  50. 50.
    Bowness P, Shotliff K, Middlemiss A, et al. Prevalence of hypothyroidism in patients with polymyalgia rheumatica and giant cell arteritis. Br J Rheum. 1991; 30: 349–351.CrossRefGoogle Scholar
  51. 51.
    Ayoub WT, Franklin CM, Torretti T. Polymyalgia rheumatica: duration of therapy and long-term outcome. Am J Med. 1985; 79: 309–315.PubMedCrossRefGoogle Scholar
  52. 52.
    Weyand CM, Xie C, Goronzy JJ. Homozygosity for the HLA-DRB1 allele selects for extraarticular manifestations in rheumatoid arthritis. J Clin Invest. 1992;89:20332039.Google Scholar
  53. 53.
    Lance NJ, Curran, JJ. Late-onset, seropositive, erosive rheumatoid arthritis. Semin Arthritis Rheum. 1993; 23: 177182.Google Scholar
  54. 54.
    Schmidt KL, Frencl V. Die rheumatoide Arthritis mit Beginn im höheren Lebensalter. Dtsch Med Wochenschr. 1982; 107: 1506–1510.PubMedCrossRefGoogle Scholar
  55. 55.
    Terkeltaub R, Esdaile J, Décary F, et al. A clinical study of older age rheumatoid arthritis with comparison to ayounger onset group. J Rheum. 1983; 10: 418–424.PubMedGoogle Scholar
  56. 56.
    Deal CL, Meenan RF, Goldenberg DL, et al. The clinical features of elderly-onset rheumatoid arthritis. Arthritis Rheum. 1985;28:987–994.Google Scholar
  57. 57.
    McCarty DJ, O’Duffy JD, Pearson L, et al. Remitting seronegative symmetrical synovitis with pitting edema.JAMA. 1985; 254: 2763–2767.Google Scholar
  58. 58.
    Steffe LA, Cooke CL. Still’s disease in a 70-year-old woman. JA MA. 1983; 249: 2062–2063.Google Scholar
  59. 59.
    Arnett FC, Edworthy SM, Bloch DA, et al. The American acteristics. J Rheum. 1984;11:175–181. Rheumatism Association 1987 revised criteria for classification of rheumatoid arthritis. Arthritis Rheum. 1988; 31: 315–324PubMedCrossRefGoogle Scholar
  60. 60.
    Griffin MR, Ray WA, Schaffner W. Nonsteroidal antiinflammatory drug use and death from peptic ulcer in elderly persons. Ann Intern Med. 1988; 109: 359–363.PubMedGoogle Scholar
  61. 61.
    Yocum DE, Klippel JH, Wilder RL, et al. Cyclosporin A in severe, treatment-refractory rheumatoid arthritis. Ann In tern Med. 1988; 109: 863–869.Google Scholar
  62. 62.
    Cash JM, Klippel JH. Second-line drug therapy for rheumatoid arthritis. N Engl J Med. 1994; 330: 1368–1375.PubMedCrossRefGoogle Scholar
  63. 63.
    Kremer JM, Phelps CT. Long-term prospective study of the use of methotrexate in the treatment of rheumatoid arthritis. Arthritis Rheum. 1992; 35: 138–145.PubMedCrossRefGoogle Scholar
  64. 64.
    Kean WF, Anastassiades TP, Dwash IL, et al. Efficacy and toxicity of D-penicillamine for rheumatoid disease in the elderly. J Am Geriatric Soc. 1982; 30: 94–100.Google Scholar
  65. 65.
    Mitchell DM, Spitz PW, Young DY, et al. Survival, progno sis, and causes of death in rheumatoid arthritis. Arthritis Rheum. 1986; 29: 706–714.PubMedCrossRefGoogle Scholar
  66. 66.
    Laakso M, Mitru O, Isomki H, et al. Mortality from amyloidosis and renal disease in patients with rheumatoid arthritis. Ann Rheum Dis. 1986; 45: 663–667.PubMedCrossRefGoogle Scholar
  67. 67.
    Watanabe-Fukunaga R, Brannan CI, Copeland NG, et al. Lymphoproliferation disorder in mice explained by defects in Fas antigen that mediates apoptosis. Nature. 1992; 356: 314–317.PubMedCrossRefGoogle Scholar
  68. 68.
    Wu J, Zhou T, He J, et al. The fas gene in 1pr mice is due to insertion of a retroviral transposon. J Exp Med. 1993; 178: 442–451.Google Scholar
  69. 69.
    Dimant J, Ginzler EM, Schlesinger M, et al. Systemic lupus erythematosus in the older age group: computer analysis. J Am Geriatr Soc. 1979; 27: 58–61.PubMedGoogle Scholar
  70. 70.
    Ballou SP, Khan MA, Kushner I. Clinical features of sys temic lupus erythematosus. Differences related to race and age of onset. Arthritis Rheum. 1982; 25: 55–60.PubMedCrossRefGoogle Scholar
  71. 71.
    Catoggio LJ, Skinner RP, Smith G, et al. Systemic lupus erythematosus in the elderly: clinical and serological characteristic. J Rheum. 1982; 25: 55–60Google Scholar
  72. 72.
    Hochberg MC, Boyd RE, Ahearn JM, et al. Systemic lupus erythematosus: a review of clinico-laboratory features and immunogenetic markers in 150 patients with emphasis on demographic subsets. Medicine. 1985; 64: 285–295PubMedCrossRefGoogle Scholar
  73. 73.
    Baer AN, Pincus T. Occult systemic lupus erythematosus in elderly men. JAMA. 1983; 249: 3350–3352.PubMedCrossRefGoogle Scholar
  74. 74.
    Studenski S, Allen NB, Caldwell DS, et al. Survival in systemic lupus erythematosus. A multivariate analysis of de mographic factors. Arthritis Rheum. 1987; 30: 1326–1331.PubMedCrossRefGoogle Scholar
  75. 75.
    Jiang X, Khursigara G, Rubin RL. Transformation of lupus-inducing drugs to cytotoxic products by activated neutrophils. Science. 1994; 266: 810–813.PubMedCrossRefGoogle Scholar
  76. Benedek TG. Neoplastic associations of rheumatic diseases and rheumatic manifestations of cancer. Clin Geriatr Med. 1988; 4: 333–355.Google Scholar
  77. 77.
    Malinow KL, Molina R, Gordon B, et al. Neuropsychiatric dysfunction in primary Sjögren’s syndrome. Ann Intern Med. 1985; 103: 344–349.PubMedGoogle Scholar
  78. 78.
    Alexander EL, Malinow K, Lejewski JE. Primary Sjögren’s syndrome with central nervous system disease mimicking multiple sclerosis. Ann Intern Med. 1986; 104: 323–330.PubMedGoogle Scholar
  79. 79.
    Medsger TA, Dixon JA, Garwood VF. Palmar fasciitis and polyarthritis associated with ovarian carcinoma. Ann Intern Med. 1982; 96: 424–431.PubMedGoogle Scholar
  80. Freundlich B, Makover D, Maul GG. A novel antinuclear antibody associated with a lupus-like paraneoplastic syndrome. Ann Intern Med. 1988; 109: 295–297.Google Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Leif B. Sorensen
  • Joy M. Blair

There are no affiliations available

Personalised recommendations