Rheumatoid arthritis (RA) is an auto-immune disease that typically occurs during middle age. However, in recent years we’ve seen a huge increase in the number of seniors being diagnosed with this condition, and this has changed the way that we see and approach the disease.
Known as elderly-onset rheumatoid arthritis (EORA), this condition can be very painful and difficult to manage, and the risk of complications increases substantially. In this guide, we’ll look at the symptoms, treatments, and risk factors, and see if we can shed some light on why the rates of EORA are increasing.
What is Rheumatoid Arthritis?
The name rheumatoid arthritis stems from the Greek words ρεύμα, meaning “flow” or “current,” and άρθρωση, meaning “joint.”
Rheumatoid arthritis often presents as a chronic inflammation of the joints that affects a connective tissue known as the synovial membrane. It can also impact the skin, blood vessels, and organs, although between 75% and 85% of cases only present in the joints.
It is said to affect between 0.5% and 1% of the developed world. The United Kingdom, Australia, Ireland, and Sweden have some of the highest rates of RA. Rates are also high in the United States and, in the last couple of decades, we’ve seen an increase in the number of high-income individuals being diagnosed with the disease.
Sub-Saharan Africa has some of the lowest rates but the life expectancy in this area is also one of the lowest in the world, hovering around 60 years old. As a result, it could simply be that many people are not living long enough to see a diagnose.
In general, rates are low outside of the developed world, but the low life expectancy rates and reduced access to healthcare and diagnostics may be at fault.
Risk Factors for Rheumatoid Arthritis
If you have a family history of rheumatoid arthritis, you are significantly more likely to develop the disease. There may also be some environmental factors involved, including exposure to silica, asbestos, and other industrial elements.
For instance, it’s said that emergency workers who were exposed to dust from the collapse of the World Trade Center were more likely to develop conditions such as rheumatoid arthritis.
Other risk factors include:
- Gender: Women are 2.5x more likely to develop RA than men.
- Age: Although there is no lower or upper age limit for RA, it most commonly occurs during middle age, defined as anywhere from 40 to 60.
- Smoking: Not only does smoking increase your risk, but it also puts you at a higher risk of developing complications.
- Weight: Obesity is a major risk factor for women between the ages of 50 and 60.
A patient with rheumatoid arthritis is more likely to develop a host of complications, including everything from carpal tunnel syndrome to heart problems and lung disease. Their risk of developing lymphoma also increases significantly.
Why is RA More Common in Seniors?
A 2017 study looked at how cases of rheumatoid arthritis had developed over time and found that, while the average age of an RA sufferer was just 55.8 years in 2002, it had increased to nearly 60 years in 2012. This number seems to have been on the rise ever since.
Does this mean that the disease has changed and is affecting people at a later date? Not necessarily. It could certainly play a role and may have something to do with changes in environmental risks and smoking habits. But there are other factors at play here:
- Diagnosis: It has been suggested that the increased rates of RA in the elderly may be the result of diagnostic mistakes. Simply put, physicians may struggle to correctly diagnose this condition and confuse it with diseases that present with similar symptoms.
- If the patient is not in severe distress and has a relatively good quality of life, they may opt for a quick diagnosis and some management medications. On the other hand, a younger patient is more likely to delve deeper and run more tests.
- Better Management: The aforementioned study looked at the average age of onset. However, one of the reasons we’re seeing many older patients with the disease could simply be a result of improved medications and treatments. As with many serious diseases, treatments improved and patients live longer, pushing the average age higher as a result.
RA vs EORA
Elderly onset rheumatoid arthritis (EORA), also known as late-onset rheumatoid arthritis (LORA), presents with many of the same symptoms as early-onset rheumatoid arthritis (RA), but with a few key differences:
- It Impacts Men and Women the Same: While women are 250% more likely to be diagnosed with RA, EORA affects both men and women equally.
- Big Joints: RA initially presents in small joints, like those in your fingers and toes. EORA, however, is more common in larger joints like the shoulders.
- Acute Onset: The symptoms of RA appear gradually over time, but the symptoms of EORA can appear quickly. This is known as “acute onset rheumatoid arthritis.”
- Less Severe: Although EORA comes on quickly and impacts large joints, it tends to have less of an impact on the patient’s life and they can often live comfortably and without any serious issues. This is due to the decreased prevalence of an antibody known as the rheumatoid factor, which attacks healthy tissues.
Treatments for Elderly Onset Rheumatoid Arthritis
Nonsteroidal anti-inflammatory drugs, steroids, and antirheumatic drugs can help keep rheumatoid arthritis under control at all ages. There is an increased risk for elderly patients, however, as they are more likely to take multiple medications, and these may interfere with the drugs prescribed to treat RA.
Physical therapy can help as well. It may not reverse the disease, but it can help make it more manageable while increasing the control you have over your remaining mobility. Light exercises performed on a regular basis can improve your strength and flexibility while also getting your heart pumping and blood flowing.
Taking the time to perform even the most basic of exercises could, therefore, have a major impact on your quality of life and longevity.