Blog: EORA, Elderly Onset Rheumatoid Arthritis

As we get older, our youthful bodies start to lose some of the agility and endurance we have always expected of ourselves. We slow down. Late nights aren’t as fun as they used to be. Food choices change. Spicy food may suddenly seem too spicy. Climbing stairs isn’t quite as easy as it once was.

Aging is a gradual process and we adjust to it as we go. Some of us feel lucky to be alive. We have friends and family who have died from cancer or heart disease. We may have the experience of surviving war, illness or accidents. And we have finally learned that we are not immortal. We see the calendar pages fly by and are starting to wonder about the condition of our maturing bodies. We look more closely at our medical insurance plan and we start making appointments with our primary care providers. We are prescribed the classic medications, a statin and maybe  a blood pressure pill. We promise ourselves to walk more and to lose a few pounds. Arthritic changes are more noticeable.

Most older adults have some osteoarthritis in their bodies. We expect to have some arthritis as we grow older. Osteoarthritis is often thought of as a disease of wear and tear. It is considered a local disease where a joint, such as the knee, degenerates and loses function.

In those over sixty another form of arthritis, rheumatoid arthritis, develops in  2 % of the population.  Normally, Rheumatoid Arthritis, the most common form of inflammatory arthritis,  occurs in the 35-55 age group (0.5-1% of the general population). Those who are over sixty-five when they develop RA have what is called Elderly Onset Rheumatoid Arthritis (EORA). It is another surprise for us when we hit our sixties.

Although rheumatoid arthritis affects the joints, it is a systemic autoimmune disease that affects major organs and systems in the body. It is not the same as osteoarthritis.

Women/men occurrence ratio changes to 2/1 as opposed to 4/1 for younger RA patients. So, more elderly men have RA than younger men.

Onset is frequently abrupt with the classic features of symmetrical, swollen proximal finger joints, toes, knuckles, feet, wrists, ankles, elbows. With EORA shoulders might be initially affected. Low grade temperature, flu-like fatigue. The onset of EORA may seem similar to polymyalgia rheumatica (PMR).

PMR is an elderly disease that frequently has an onset of anywhere from fifty to seventy years. Seventy is a common time of onset. It is not seen in young people. Symptoms are similar to EORA, but PMR is not a symmetrical disease and initially may affects larger joints such as the hip and lower spine and it usually includes  muscle pain.

Treatment for EORA is similar to treatment for younger patients with RA. Prednisone may be prescribed as a bridge therapy until DMARDs (disease modifying anti-rheumatic drugs) have time to start working. DMARDs reduce inflammation but also slow the disease process. Methotrexate is the most commonly prescribed DMARD. Side effects include nausea and diarrhea which subside with time. RA drugs range from Hydroxychloquine (Plaquenil) to the biologics such as Etanercept (Embrel). Elderly Onset Rheumatoid Arthritis like its younger version is not curable. It can be managed well with treatment.

Failure to treat RA will result in increased disease activity and eventually irreversible damage to joints.  Having the right diagnosis for your arthritis is important so that you will receive the treatment appropriate for your body.

Acquiring RA as we age adds another layer of coping to a body that is already feeling the effects of time. Managing the disease requires a level of determination to stay well that some have a hard time achieving. It is doable. Life can be good with RA. Newer treatments have changed RA from  a horrifying disease to one that is manageable with good outcomes. Well managed RA  makes life  good again.