Advances in the diagnosis and treatment of rheumatoid arthritis in elderly patients

Rheumatoid arthritis (RA) is a systemic autoimmune disease that mainly manifests as symmetrically, continuously and erosive polyarthriti multiple arthritis mainly involving small joints such as the proximal interphalangeal joints, metacarpophalangeal joints, and wrist joints of both hands. Elderly patients with RA refers to patients with this disease with an age ed over 60 years. Elderly patients with RA are classified into two clinical subsets, namely, elderly-onset RA (EORA) and younger-onset elderly RA (YORA). The population of elderly with RA is expanding because of the aging of populations and increased life expectancy. EORA seems to have an epidemiological character and a clinical pattern different from that of YORA. A prompt diagnosis of true RA is important to implement early treatment. The diagnosis of EORA from other rheumatological disorders, such as polymyalgia, gouty arthritis and osteoarthritis, which are prevalent in this stratum of the population, are different. The method for diagnosing EORA lacks specificity. In addition, this disease exhibits symptoms similar to EORA, which makes diagnosis more difficult at the early stage. The treatment of EORA aims to achieve the same objectives as in the treatment of YORA, that is, to control clinical manifestations, prevent structural damage, preserve functions and decrease excess mortality. Owing to pharmacokinetics changes, high renal insufficiency, age-related immunosenescence and other risk factors, the management of patients with EORA is challenging. Currently, the drugs used to treat RA include Nonsteroidal anti-inflammatory drug (NSAIDs), glucocorticoid, traditional disease-modifying anti-rheumatic drugs (csDMARD), biological DMARDs (BDMARDs) and targeted synthetic DMARDs (TsDMARDs). Patients with EORA should be carefully monitored because of high risk of adverse events associated with treatment. A tailored approach that aims to achieve clinical remission should be adopted on the basis of disease severity and risk profiles of patients with EORA.