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Elderly onset rheumatoid arthritis (EORA) is a misnomer since it refers to rheumatoid arthritis affecting people 60 years of age or older. Since this author recently reached the age of 60 and certainly doesn't consider himself elderly, the definition should be changed.
Rheumatoid arthritis (RA) affects 2% of those 60 years old and older and is generally more common among women. When RA presents in patients past the age of 60, it may present with an acute onset, with significant inflammatory symptoms Wholesale Adidas NHL Jerseys , and predominant upper extremity involvement, eg. shoulders. Inflammatory markers in the blood such as the erythrocyte sedimentation rate (ESR) may be greatly elevated.
Diagnostic testing is similar to that for diagnosing RA in younger individuals. Acute phase reactants for inflammation such as the ESR and CRP will invariably be abnormal. Serologic testing for rheumatoid factor and anti-cyclic citrullinated protein (anti-CCP) are helpful.
The diagnostic imaging procedure of choice is probably magnetic resonance imaging (MRI), although diagnostic ultrasound may be useful.
Other disease processes that need to be excluded include: calcium pyrophosphate deposition disease (CPPD), osteoarthritis Wholesale New NHL Jerseys , gout, polymyalgia rheumatica (PMR), arthritis associated with infections such as hepatitis B,C Wholesale NHL Jerseys Cheap , and immunodeficiency virus. Tuberculosis and fungal infections such as histoplasmosis, coccidiomycosis, and blastomycosis can also present with inflammation of many joints.
Endocrine disorders such as diabetes and Cushing's disease may also present with diagnostic challenges.
Malignancy is another consideration. An inflammatory arthritis affecting many joints in a patient over the age of 60 should lead the physician to working up the patient for an underlying malignancy. Also, certain malignancies such as lymphoma are increased in incidence in patients with rheumatoid arthritis.
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