Rheumatoid arthritis in the elderly. Prevalence and optimal management.

Elderly-onset rheumatoid arthritis (EORA), defined as rheumatoid arthritis (RA) with onset at age 60 years or over, differs slightly from younger-onset RA by a more equal gender distribution, a higher frequency of acute systemic onset with involvement of the shoulder, a higher disease activity, and, in later stages, more radiographic damage and functional decline. Several subsets of EORA are recognised, such as rheumatoid factor-positive RA, polymyalgia rheumatica and 'remitting seronegative symmetrical synovitis with pitting oedema'. These conditions can be difficult to distinguish from crystal-induced arthritis, osteoarthritis and paraneoplastic arthritis. The efficacy and tolerability of second-line drugs is similar in both age groups, but in the elderly caution is needed with the use of nonsteroidal anti-inflammatory drugs and prednisone.