Rheumatoid arthritis (RA) is an autoimmune disease that occurs when the body’s immune system mistakenly attacks healthy joints. It can begin at any age, but the chance of onset is highest in older adults.
The new onset of RA occurs
An estimated 1.9 million people in the United States have RA. There can be differences between EORA and RA that occurs in younger people, or younger onset RA (YORA), and it is important to be aware of these.
In this article, we look at the symptoms, diagnosis, and treatment of EORA, as well as the outlook for people with this condition.
In RA, the tissue lining the joints becomes thickened, resulting in swelling and pain. As time passes, the cartilage and bone can also become damaged. The signs that may indicate RA
- pain, aching, tenderness, swelling, or stiffness in more than one joint
- the same symptoms on both sides of the body, such as in both shoulders or knees
- unintentional weight loss
EORA can affect people slightly differently than YORA. According to research from 2019, EORA is more likely to:
- Affect males and females more evenly: YORA is
more likelyto occur in females, with a sex ratio of 4:1. In EORA, the ratio is less uneven, at 2:1.
- Affect the shoulders: EORA affects large joints, such as the shoulders, more frequently than YORA.
- Occur alongside other conditions: About 50–75% of EORA cases occur with other conditions, or comorbidities. These comorbidities can influence how doctors treat the RA.
- Have similarities with polymyalgia rheumatica (PMR): PMR is a medical condition that has some similarities with RA. It causes joint pain and stiffness in the morning, along with extreme tiredness and weight loss. In older adults, RA may be difficult to distinguish from PMR. This similarity is rare in people with YORA.
Early diagnosis and treatment are key to successful RA management because joint damage is irreversible once it takes place.
However, older adults also tend to be underdiagnosed for RA, which can be difficult to diagnose because it can mimic other illnesses, such as PMR. Additionally, although there are tests that can suggest RA, they are not always conclusive.
Doctors can diagnose RA by:
- taking the person’s medical history
- performing a physical exam of the affected joints
- requesting blood tests for biomarkers of autoimmunity, such as rheumatoid factor (RF) and anticitrullinated protein antibody (ACPA)
- recommending PET or CT scans
In older adults, the presence of RF in the blood does not always indicate an autoimmune disease. About 10% of healthy people aged 60 years and over have RF in their blood. Additionally, it is possible to have RA even if the blood tests for RF and ACPA are negative. This is known as seronegative EORA.
It is important to treat EORA right away. Most of the same drugs that doctors use to treat YORA work for EORA too.
A doctor may suggest:
- short-term treatment with prednisone, a steroid that reduces inflammation
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- immunosuppressant drugs, which reduce the activity of the immune system
- disease-modifying antirheumatic drugs, such as sulfasalazine (Azulfidine), leflunomide (Arava), and the immune suppressant methotrexate (Trexall)
Older adults can be more susceptible to steroid-related side effects, including diabetes, osteoporosis, and hypertension. Due to this, doctors should only use prednisone to lower inflammation quickly before trying other options.
If someone has other conditions that prevent them from taking steroids or other RA drugs, healthcare professionals can take this into consideration to find the best treatment option for them.
In addition to medication, there are things that older adults can do to manage and reduce their symptoms, such as:
- Staying physically active: Stretching and moderate exercise are
criticalcomponents in managing EORA. However, it can feel difficult to do this when RA causes joint pain. To participate in safe activities, people may find it helpful to consult a physical therapist or join a disability-friendly exercise class.
- Resting the joints: Although exercise is beneficial, it is also important to rest the joints that RA affects so that they have a chance to recover. People may wish to use supportive splints for joints that are inflamed. It is also possible to purchase devices that make using the affected joint easier, such as door handle extenders and electric can openers.
- Stopping smoking: Tobacco smoke
makes RA worse. It can also make it more challenging to stay physically active, which makes managing RA more difficult.
- Maintaining a moderate weight: Excess body weight can place additional pressure on the joints.
- Joining an RA management class: Attending these classes can help people learn how to manage and control their symptoms and improve their quality of life. The CDC lists self-management programs on its
- Getting adequate sleep: A 2017 study of 112 people with RA found that only 18.5% of participants had good sleep. Addressing difficulty sleeping can help improve mood and energy levels, making it less difficult to manage RA. People may wish to discuss ways of doing this with a doctor, particularly if they suspect that they have a sleep disorder, such as sleep apnea.
- Adjusting the home environment: Temperature and weather can affect RA symptoms. If a person notices that cold, hot, or humid weather affects their symptoms, they may be able to make changes to the home accordingly. For example, if cold weather makes RA worse, a person can take steps to make sure that it is warm indoors.
People with EORA generally have a less positive outlook than those with YORA, as EORA tends to cause more disability. It also has lower rates of remission and can shorten a person’s lifespan. However, there have been advancements in the understanding and treatment of the disease.
Early diagnosis leads to a better outlook. For this reason, anyone with symptoms that could indicate RA should speak with a doctor as soon as they can. Keeping a symptom diary and preparing a list of questions ahead of time can help.
Treating comorbidities may also reduce the impact of EORA. A single-center 2020 study found that treating conditions such as diabetes or interstitial lung disease had a positive effect on older adults with RA.
EORA is a type of inflammatory arthritis that occurs as a result of the body’s immune system attacking the joints, leading to pain, swelling, and stiffness. In older adults, it tends to affect larger joints, such as the shoulders. It also causes various other symptoms, including fatigue and weight loss.
Anyone who develops the symptoms of RA should speak with a doctor as soon as possible because an early diagnosis typically leads to the best outcomes.