YA?LI BA?LANGI?LI ROMATO?D ARTR?T: KL?N?K ?ZELL?KLER? ve AYIRICI TANISI

摘要

Rheumatoid arthritis (RA) is one of the common inflammatory diseases of the adulthood. The term late onset RA (LORA) is used when the symptoms of RA start after 60 years of age. In earlier times LORA was thought to have a milder course than that of the young onset RA (YORA). However later studies have shown that LORA can have as severe a clinical course as YORA. LORA has an acute onset rather than an insidious one of YORA; the first site of involvement can be the shoulders rather than the more common articular sites of hand and foot of YORA. Because of the tendency for an atypical onset of the disease, differential diagnosis of LORA should include infectious diseases, neoplasia, polymyalgia rheumatica, RS3PE, gout, pseudogout and seronegative spondyloarthropathies. The therapy must be cautiously monitored as older patients with RA may have additional health problems like atherosclerosis, hypertension, diabetes; plus the pharmacokinetics and pharmacodynamics of drugs can be altered due to physiological aging process. Considering the fact that LORA can have as severe a clinical course as YORA, methotrexate is one of the first drugs to be considered for suppressing the clinical activity.