Rheumatoid Arthritis in people over 65

Although the most frequent age of onset is 35 to 55 years, RA not infrequently occurs for the first time in older people, up to age 70 and older.

Clinical features are similar to those in a younger age group.

Usually the onset is insidious with development of joint stiffness and swelling over several months. In about a quarter of people, the onset takes place more rapidly, over a period of days or weeks, and is associated with more generalised symptoms that may include night sweats and fever.

Some people with RA have a decline in disease activity and are left with residual disability due to joint damage.

In others, the disease remains active and they continue to develop new nodules and associated sequelae of RA, such as vasculitis.

The principles of treatment are similar to those in younger people. There are some noticeable differences however, and these include:

Treatment goals should take into account other disabilities. For example, major joint surgery may not be considered appropriate in elderly people with major deformities of the feet or other problems that preclude eventual walking or independence.

Treatment goals may need to be scaled down in people with significant cognitive impairment.

Many people may be depressed, and this may require treatment in its own right.

Undernutrition is a common problem and requires careful assessment and treatment.

Social support and the provision of assistive equipment and environmental modifications should take high priority.