Specific Features of Rheumatic Diseases at an Advanced Age

Polymyalgia rheumatica and arteritis temporalis are characteristic rheumatic diseases of advanced age. Concomitantly, peripheral arteritis of large vessels occurs at higher ages. Required diagnostics and current recommendations for the therapy of these diseases are discussed in the present review. Rheumatoid arthritis can develop at advanced age (late onset rheumatoid arthritis/LORA) or patients, whose rheumatoid arthritis commenced at younger age, have grown old with their chronic disease (young onset rheumatoid arthritis/YORA). Considerable differences between LORA and YORA can be found for clinical patterns (worse functional capacity in LORA), for laboratory parameters (lower rheumatoid factor and ACPA in LORA), and for outcome. Rheumatoid factor negative LORA predominantly shows a favourable disease course than one with a positive rheumatoid factor. Radiological progression is more prominent in LORA patients with rheumatoid factor than in the corresponding YORA patients. Furthermore, at the same disease duration LORA patients suffer from more comorbid conditions than YORA patients. LORA patients are treated less aggressively, in particular, biologics are less frequently prescribed. Late onset systemic lupus erythematosus (LO-SLE) shows in general a milder disease activity than SLE of early onset, but is accompanied by more cardiovascular, ocular and musculo-skeletal damage. Therefore LO-SLE is not a benign disease. The specific features of rheumatic diseases at advanced age deserve closer attention in an increasingly older-growing population.