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Rheumatoid Arthritis (RA) in the Elderly

Rheumatoid arthritis is the second most common type of arthritis, following osteoarthritis. It is one of the severely debilitating joint disease in seniors. Although it tends to start earlier in life, it is the elderly that tend to suffer the worst complications and most severe forms of associated disability. Rheumatoid arthritis is a chronic disease that affects different organs but mainly involves the small joints of the hands and feet.

Inflammation of the capsule around the joint is the main reason behind the symptoms of rheumatoid arthritis. About 1% of the world’s populations suffer from rheumatoid arthritis and this is across all age groups although it is more common in adults than children. Although not widely known, rheumatoid arthritis is not solely a disease of the joints. The disease can affect other organs like skin, lungs, eyes, kidneys and heart.

Symptoms of Rheumatoid Arthritis

The symptoms depend upon the organ involved. The joints are the most commonly affected site in the majority of patients. However, the elderly are more likely to experience involvement of other organs and these symptoms are known as the extra-articular manifestations.

  • Painful, swollen and warm joints. Usually the smaller joints of the body like those of the hand and feet are affected initially but with progression of the disease, large joints of the body like shoulder or knee may be affected. The affected joints characteristically remain stiff especially during morning after waking up or after prolonged inactivity. Often with progression of the disease there is erosion of the affected joints along with specific deformities of the fingers and toes.
  • In many patients, there are nodules on the skin. This type of nodule may also be found on bony prominences. Other skin changes include purple discoloration (livedo reticularis), skin ulcer, fragile skin and thinning of the skin.
  • Fluid may accumulate in the pleural sac, the covering of lungs, leading to respiratory distress and chest pain.
  • Impaired kidney function leading to reduced urine output.
  • Dryness of the eyes with redness and irritation.
  • Anemia contributing to fatigue and paleness.
  • Tingling and numbness of limbs which may progress to muscle weakness and even paralysis. Sometimes the nerve supplying the muscles of the palm is compressed leading to loss of grip strength.
  • Generalized symptoms such as fatigue, loss of body weight and poor appetite.
  • Bone weakness with an increased risk of fractures.

Causes and Risk Factors

Rheumatoid arthritis is an autoimmune disease that occurs due to improper stimulation of the immune system. In autoimmune diseases, the immune system mistakenly recognizes the body’s own tissue (self proteins) as foreign and starts directing its action against it. In rheumatoid arthritis, it is the synovial membrane which is mainly affected. The synovial membrane that lines the joint cavity is the most commonly affected body part.

In response to inflammation the synovial membrane becomes thick and gradually there is erosion of the bones and adjacent cartilages leading to joint damage and deformity. The exact factors that trigger the immune response are not known. However, certain factors are assumed to be responsible such as genes and infections. This then disrupts the body’s immune responses.

People who are more likely to develop risk factors include :

  • Women are more commonly affected than men.
  • Being in the 40 to 60 year age group.
  • Family history.
  • Cigarette smoking.

Treatment of Rheumatoid Arthritis

There is no definitive cure for rheumatoid arthritis. Drugs are effective in managing the condition but do not cure the condition completely. These drugs include anti-inflammatory medications like NSAIDs, steroids, immunosppressants, disease modifying agents and TNF alpha inhibitors. Regular exercise helps improve joint flexibility and stiffness reduction. If drugs fail to halt progression of the disease, surgery is done to improve joint function. The elderly who are more likely to develop complication often need reconstructive joint surgery.


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