Imagine my surprise when I learned about the initials YORA and EORA. YORA is an acronym for Younger Onset Rheumatoid Arthritis as is EORA for Elderly Onset Rheumatoid Arthritis. I came to a new understanding of where I am in the scheme of things.
Rheumatoid Arthritis (RA) can strike at any age from babies to the elderly. The elderly’s association with RA can be of long standing disease or it can be a new development. People who develop RA after age 60 are considered EORA. That is me.
There are some notable differences with elderly onset RA. Initial symptoms may include large joints. With younger RA onset small joints of the hands and the feet are usually first signs of joint involvement. The shoulder joint may be a presenting joint in older onset. My shoulder was involved initially as was the joints in my hands, wrists, feet, elbows. Initially I was in severe pain. Older adults may have more generalized symptoms. My grip was weak. I lost weight. I couldn’t sleep because of the severity of the pain. I was nauseated and I lost my appetite. Of my labs, my ESR and my CRP were sky high. I was a mess.
Treatment for the elderly is the same as for those younger. Many studies confirm the safety of DMARDs (Disease Modifying Anti-Rheumatic Drug), including the biologics, for the elderly. I have been on methotrexate for four years. Initially, I had the side effects of nausea and diarrhea. I don’t have any side effects now. Methotrexate works best when in combination with another DMARD. I have tried all the non-biologic DMARDs. I can tolerate hydroxychloroquine. I have taken the two drugs for a long time. I have a thorough eye exam yearly to be sure my eyes are not being affected by the hydroxychloroquine. I have labs every three months to be sure I am not having any adverse reaction to the methotrexate.
I have tried infusions of three biologics. Orencia worked the longest. Rituxan did not work at all. Remicade, a TNFi, made me very sick. My doctor wants me to try Actemra next. She is adamant. She feels Actemra is safer than prednisone. I think doctors have a blind spot with regards to prednisone. I have had no side effects. My bone density is excellent. My blood sugar goes down as my prednisone dose increases.
Drugs like ibuprofen and aspirin need to be used cautiously. The NSAID (Non-Steroidal Anti-Inflammatory) class of drugs is well known for causing stomach and heart issues. It also causes kidney issues. This class of drugs, so well used in the past, has fallen out of favor with the medical community as more studies uncover the problems associated with them.
RA in the elderly is often more painful with more activity restrictions. It must be treated as thoroughly as are those with RA who are younger. I have never felt my age. I never lumped myself with the elderly or with any group. My doctor doesn’t seem to lump me either. She is giving me her best shot. I don’t mind being a EORA. Which are you? EORA or YORA?