Rheumatoid arthritis in the aged. Incidence and optimal management.

Rheumatoid arthritis (RA) is estimated to occur in 0.3 to 3% of the general population. Up to one-third of RA patients first present for treatment after the age of 60 years (elderly-onset RA). The overall frequency in individuals older than 65 is increased, so that 30 to 40% of RA patients treated in rheumatology centres are > 60 years of age. Optimal management of all RA patients includes physical therapy, medications, both nonsteroidal anti- inflammatory drugs (NSAIDs) and remittive agents, and, in some cases, surgery. In the elderly, these treatment modalities at times need to be altered to accommodate age-related changes in body mechanics and organ function. Thus, the approach to physical therapy in older patients is different than in the young. There are fewer rest periods and more passive exercises. Drug treatment must also be modified, since NSAIDs and several remittive agents are more hazardous in elderly patients. Indications for orthopaedic procedures may also be different. The long term management of RA requires a delicate balance of benefit and risk. It is wise to begin with the least toxic medications. However, if necessary, potentially toxic medications can be given cautiously, with close monitoring for adverse effects.