Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-30T20:20:42.050Z Has data issue: false hasContentIssue false
  • English
  • Français

Management of inflammatory arthritis in older people

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  12 February 2010

Z Paskins ,
SN Kamath  and
AB Hassell
Z Paskins*
Affiliation:
Staffordshire Rheumatology Centre (University Hospital of North Staffordshire NHS Trust), Haywood Hospital, Stoke on Trent, UK
SN Kamath
Affiliation:
Staffordshire Rheumatology Centre (University Hospital of North Staffordshire NHS Trust), Haywood Hospital, Stoke on Trent, UK
AB Hassell
Affiliation:
Staffordshire Rheumatology Centre (University Hospital of North Staffordshire NHS Trust), Haywood Hospital, Stoke on Trent, UK
*
Address for correspondence: Dr Z Paskins, Clinical Lecturer in Rheumatology, Arthritis Research Campaign National Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire ST5 5BG, UK. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

Musculoskeletal symptoms are extremely common, with almost one-third of people aged 75 years and over having a significant musculoskeletal problem. Joint pain due to inflammatory arthritis is important to identify, as it is potentially treatable. In elderly patients, inflammatory arthritis may not present in the ‘classical’ way, may present with non-specific symptoms and may co-exist with other musculoskeletal problems, all of which can result in diagnostic difficulty. In addition, co-morbid conditions and polypharmacy may present treatment challenges. In this paper, we discuss the general considerations in the clinical evaluation and management of a patient with inflammatory joint symptoms and discuss in more detail the diagnosis and management of the common causes of inflammatory arthritis.

Keywords

inflammatory arthritisagedrheumatoid arthritiscrystal arthritis
Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 20 , Issue 1 , February 2010 , pp. 42 - 55
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Martin, J, Meltzer, H, Elliot, D. The prevalence of disability among adults. OPCS surveys of Great Britain. Report 1, OPCS Social Surveys Division, 1988, HMSO, London.Google Scholar
2Calkins, E. Clinical presentations in different age groups: the geriatric population. In Oxford Textbook of Rheumatology, Isenberg, D et al. (eds). 2004, Oxford University Press, Oxford.Google Scholar
3Arthur, K. Rheumatic diseases in the elderly: a perfect storm. Clin Geriatric Med 2005; 21: xi–xiii.Google Scholar
4Kamath, S, Hassell, AB. Management of inflammatory arthritis in the older person. Rev Clinical Gerontology 2003; 13: 283–96.CrossRefGoogle Scholar
5National Health Service (NHS). Evidence Health Information Resources. Available from: http://www.library.nhs.uk/default.aspx (accessed 2 Nov 2009).Google Scholar
6Creamer, P et al. Acute inflammatory polyarthritis in association with tamoxifen. Br J Rheumatol 1994; 33: 583–85.CrossRefGoogle ScholarPubMed
7Garg, A, Radvan, J, Hopkinson, N. Drug points: Clopidogrel associated with acute arthritis. BMJ 2000; 320: 483a.Google Scholar
8Ruffatti, A et al. Autoantibodies of systemic rheumatic diseases in the healthy elderly. Gerontology 1990; 36: 104–11.CrossRefGoogle ScholarPubMed
9Juby, AG et al. Prevalence of selected autoantibodies in different elderly subpopulations. Br J Rheumatol 1994; 33: 1121–24.CrossRefGoogle ScholarPubMed
10Nishimura, K et al. Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Internal Med 2007; 146: 797–808.CrossRefGoogle ScholarPubMed
11Medicines and Healthcare Products Regulatory Agency and the Commission on Human Medicines. Non-steroidal anti-inflammatory drugs: reminder on renal failure and impairment. Drug Safety Update 2009; 2: 4.Google Scholar
12National Health Service Clinical Knowledge Summaries. Non-steroidal anti-inflammatory drugs (standard or coxibs) – prescribing issues 2008; available from: http://www.cks.nhs.uk/nsaids_prescribing_issues (accessed 19 Nov 2009).Google Scholar
13Kearney, PM et al. Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ 2006; 332: 1302–8.Google Scholar
14Medicines and Healthcare Products Regulatory Agency and the Commission on Human Medicines. Non-steroidal anti-inflammatory drugs: cardiovascular risk. Drug Safety Update 2009; 2: 3.Google Scholar
15Royal College of Physicians. Glucocorticoid-induced osteoporosis: guidelines for prevention and treatment. 2002; Royal College of Physicians, London.Google Scholar
16Hoes, JN et al. EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 2007; 66: 1560–67.Google Scholar
17Bajocchi, G et al. Elderly onset rheumatoid arthritis: clinical aspects. Clin Exp Rheumatol 2000; 18 (suppl. 20): S49–50.Google Scholar
18Pease, CT et al. Polymyalgia rheumatica can be distinguished from late onset rheumatoid arthritis at baseline: results of a 5-year prospective study. Rheumatology 2009; 48: 123–27.CrossRefGoogle Scholar
19Lopez-Hoyos, M et al. Clinical utility of anti-CCP antibodies in the differential diagnosis of elderly-onset rheumatoid arthritis and polymyalgia rheumatica. Rheumatology 2004; 43: 655–57.CrossRefGoogle ScholarPubMed
20del Rincón, ID et al. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis and Rheumatism 2001; 44: 2737–45.3.0.CO;2-#>CrossRefGoogle Scholar
21Luqmani, R et al. British Society for Rheumatology and British health professionals in rheumatology guidelines for the management of rheumatoid arthritis (the first two years). Rheumatology 2006; 45: 1167–69.CrossRefGoogle ScholarPubMed
22Kojima, M et al. Depression, inflammation, and pain in patients with rheumatoid arthritis. Arthritis Care Res 2009; 61: 1018–24.CrossRefGoogle ScholarPubMed
23Wright, GE et al. Age, depressive symptoms, and rheumatoid arthritis. Arthritis Rheumatism 1998; 41: 298–305.3.0.CO;2-G>CrossRefGoogle ScholarPubMed
24Nell, VP et al. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology 2004; 43: 906–14.Google Scholar
25Alivernini, S et al. Leflunomide treatment in elderly patients with rheumatoid or psoriatic arthritis: retrospective analysis of safety and adherence to treatment. Drugs Aging 2009; 26: 395–402.Google Scholar
26Dahl, SL et al. Second-line antirheumatic drugs in the elderly with rheumatoid arthritis: a post hoc analysis of three controlled trials. Pharmacotherapy 1990; 10: 79–84.CrossRefGoogle ScholarPubMed
27Tutuncu, Z et al. Do patients with older-onset rheumatoid arthritis receive less aggressive treatment? Ann Rheum Dis 2006; 65: 1226–29.CrossRefGoogle ScholarPubMed
28Schmajuk, G et al. Treatment of older adult patients diagnosed with rheumatoid arthritis: improved but not optimal. Arthritis Rheumatism 2007; 57: 928–34.CrossRefGoogle Scholar
29National Institute for Health and Clinical Excellence. Rheumatoid arthritis: the management of rheumatoid arthritis in adults [CG79]. 2009; National Institute for Health and Clinical Excellence, London.Google Scholar
30Gardner, G, Furst, DE. Disease-modifying antirheumatic drugs. Potential effects in older patients. Drugs Aging 1995; 7: 420–37.CrossRefGoogle ScholarPubMed
31National Institute for Health and Clinical Excellence. Rheumatoid arthritis – adalimumab, etanercept and infliximab [TA130]. 2007; National Institute for Health and Clinical Excellence, London.Google Scholar
32Bathon, JM et al. Safety and efficacy of etanercept treatment in elderly subjects with rheumatoid arthritis. J Rheumatol 2006; 33: 234–43.Google Scholar
33Fleischmann, R, Iqbal, I. Risk: benefit profile of etanercept in elderly patients with rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis. Drugs Aging 2007; 24: 239–54.CrossRefGoogle ScholarPubMed
34Genevay, S et al. Tolerance and effectiveness of anti-tumor necrosis factor alpha therapies in elderly patients with rheumatoid arthritis: a population-based cohort study. Arthritis Rheumatism 2007; 57: 679–85.CrossRefGoogle ScholarPubMed
35Radovits, BJ et al. Missed opportunities in the treatment of elderly patients with rheumatoid arthritis. Rheumatology 2009; 48: 906–10.Google Scholar
36Salvarani, C, Cantini, F, Oliveri, I. Disease-modifying antirheumatic drug therapy for psoriatic arthritis. Clin Exp Rheum 2002; 20 (suppl 28): S71–5.Google Scholar
37National Institute for Health and Clinical Excellence. Adalimumab for the treatment of psoriatic arthritis [TA125]. 2007; National Institute for Health and Clinical Excellence, London.Google Scholar
38National Institute for Health and Clinical Excellence. Etanercept and infliximab for the treatment of psoriatic arthritis [TA104]. 2006; National Institute for Health and Clinical Excellence, London.Google Scholar
39Wise, CM. Crystal-associated arthritis in the elderly. Rheumatic Dis Clinics N Am 2007; 33: 33–55.CrossRefGoogle ScholarPubMed
40Roddy, E, Zhang, W, Doherty, M. The changing epidemiology of gout. Nature Clin Prac Rheumatol 2007; 3: 443–49.CrossRefGoogle ScholarPubMed
41Zhang, W et al. EULAR evidence based recommendations for gout – Part I Diagnosis: Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2006; ard.2006.055251.CrossRefGoogle Scholar
42Jordan, KM et al. British Society for Rheumatology and British Health Professionals in Rheumatology Guideline for the Management of Gout. Rheumatology 2007: kem056a.CrossRefGoogle Scholar
43Zhang, W et al. EULAR evidence based recommendations for gout – Part II Management: Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2006; ard.2006.055269.Google Scholar
44Coakley, G et al. BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatology 2006; 45: 1039–41.Google Scholar
45Solomon, DH et al. Uric acid lowering therapy: prescribing patterns in a large cohort of older adults. Ann Rheumatic Diseases 2008; 67: 609–13.Google Scholar
46National Institute for Health and Clinical Excellence. Febuxostat for the management of hyperuricaemia in people with gout [TA164]. 2008; National Institute for Health and Clinical Excellence, London.Google Scholar
47Perez-Ruiz, F et al. Efficacy of allopurinol and benzbromarone for the control of hyperuricaemia. A pathogenic approach to the treatment of primary chronic gout. Ann Rheumatic Diseases 1998; 57: 545–49.Google Scholar
48Puig, JG et al. Effect of eprosartan and losartan on uric acid metabolism in patients with essential hypertension. J Hypertension 1999; 17: 1033–39.Google Scholar
49Bastow, MD, Durrington, PN, Ishola, M. Hypertriglyceridemia and hyperuricemia: effects of two fibric acid derivatives (bezafibrate and fenofibrate) in a double-blind, placebo-controlled trial. Metabolism: Clin Exp 1988. 37: 217–20.Google Scholar
50Singh, H, Torralba, KD. Therapeutic challenges in the management of gout in the elderly. Geriatrics 2008; 63: 13–18, 20.Google ScholarPubMed
51Announ, N, Guerne, PA. Treating difficult crystal pyrophosphate dihydrate deposition disease. Curr Rheumatol Rep 2008; 10: 228–34.Google Scholar
52Dasgupta, B, Matteson, EL, Maradit-Kremers, H. Management guidelines and outcome measures in polymyalgia rheumatica (PMR). Clin Exp Rheumatol 2007; 25 (suppl 47): 130–36.Google Scholar
53McCarty, DJ et al. Remitting seronegative symmetrical synovitis with pitting edema: RS3PE syndrome. JAMA 1985; 254: 2763–67.Google Scholar
54Olivieri, I, Salvarani, C, Cantini, F. RS3PE syndrome: an overview. Clin Exp Rheumatol 2000; 18 (suppl 20): S53–55.Google ScholarPubMed
55Cantini, F et al. Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome: a prospective follow up and magnetic resonance imaging study. Ann Rheum Dis 1999; 58: 230–36.Google Scholar
56Symmons, DPM. Malignant conditions presenting with musculoskeletal symptoms. In Oxford Textbook of Rheumatology, Isenberg, D et al. (eds). 2004; Oxford University Press, Oxford.Google Scholar
57Chakravarty, K et al. BSR/BHPR guidelines for disease-modifying anti-rheumatic drug (DMARD) therapy in consultation with the British Association of Dermatologists. Rheumatology 2008; 47: 924–25.Google Scholar