Elderly onset rheumatoid arthritis is an autoimmune condition that develops in older adults. It causes the same symptoms that ‘classic’ rheumatoid arthritis causes, like joint pain and stiffness, but it can progress differently.

Elderly onset rheumatoid arthritis is a term used to describe the slightly different manifestations of rheumatoid arthritis when it’s diagnosed in older adults. Elderly onset rheumatoid arthritis is an autoimmune condition that develops when your immune system attacks healthy cells in your joints.

Rheumatoid arthritis was once considered a younger person’s disease, but it can develop at any age. In fact, researchers now believe your risk increases with age. According to the Centers for Disease Control and Prevention (CDC), rheumatoid arthritis is most often diagnosed in people in their 60s.

Elderly onset rheumatoid arthritis progresses a bit differently than young onset rheumatoid arthritis (YORA). Symptoms tend to develop more quickly and are more likely to affect larger joints.

In this article, we take a deeper look at this condition including its symptoms, how it’s diagnosed, and how it’s treated.

Elderly onset rheumatoid arthritis (EORA) is rheumatoid arthritis (RA) that develops at an older age. Unlike osteoarthritis, the most common type of arthritis diagnosed in older adults, EORA isn’t caused by wear and tear or degeneration of the joints.

Some researchers consider EORA as rheumatoid arthritis that develops after the age of 65, while others define it as rheumatoid arthritis that develops after age 60. Like “classic” rheumatoid, it’s an autoimmune condition.

Rheumatoid arthritis develops when your immune system mistakenly attacks healthy cells in your joints. It causes inflammation and symptoms, such as joint pain, swelling, and stiffness.

Researchers estimate that EORA makes up about 10% to 33% of all cases of rheumatoid arthritis.

While it’s technically the same condition, EORA tends to present differently than rheumatoid arthritis in younger people.

Here are some of the differences researchers have found between EORA and YORA:

  • More equal distribution among sexes: Researchers have found that, in people under 50 years, rheumatoid arthritis is four to five times more common in women, according to a study that grouped participants in men and women categories. But during the ages of 60 to 70, it’s only about two times more common in women.
  • Lower incidence of rheumatoid factor:According to the National Health Service, about half of all people with rheumatoid arthritis have elevated levels of rheumatoid factor in their bloodstream when the disease starts. This molecule is produced when your immune system attacks healthy tissue. Elevated levels of rheumatoid factor seem to be less common in people with EORA than with YORA.
  • More large joint involvement:Various studies have found evidence that both small and large joints are affected more frequently at the onset of EORA than YORA.
  • Higher disease activity:EORA tends to progress faster and have higher disease activity than YORA.
  • Faster onset: EORA symptoms tend to develop suddenly and quickly, while symptoms of YORA develop more slowly and fluctuate over time.

Like YORA, EORA can affect any joint but most commonly affects the hands, wrists, and knees. In older people, rheumatoid arthritis is more likely to appear in large joints like the knees and shoulders.

EORA often causes symptoms in multiple joints and often occurs on both sides of your body. Symptoms tend to alternate between flare-ups and periods where symptoms improve.

Joint symptoms can include:

  • pain or aching
  • stiffness
  • tenderness

Some people also develop general symptoms, such as:

People with rheumatoid arthritis often develop other health problems, such as:

Diagnosing EORA can be difficult because many conditions cause similar symptoms. But prompt diagnosis is important because treatment can help prevent further joint damage.

The diagnostic process typically begins with a primary care doctor. They’ll check your joints for swelling and ask you about your symptoms. Your doctor may refer you to another doctor, called a rheumatologist, who specializes in rheumatoid arthritis.

No single blood test can indicate rheumatoid arthritis. Your doctor will use several different tests to help them reach a diagnosis. But the results of certain blood tests can be suggestive of rheumatoid arthritis and help rule out other conditions. Some of the primary blood tests that doctors use include:

Doctors may also order rheumatoid factor and anti-CCP antibody blood tests. People who test positive for both rheumatoid factor and anti-CCP may be more likely to have severe arthritis.

Imaging tests may be ordered to analyze your joints for inflammation and damage. These tests may be able to help your doctor differentiate rheumatoid arthritis from other conditions and types of arthritis. They can also help monitor the progression of your disease.

The main imaging tests used are X-rays and magnetic resonance imaging (MRI). Another option is musculoskeletal ultrasound, which is a simple, in-office exam that can help doctors identify issues in soft tissues like muscles, tendons, and ligaments.

Treating rheumatoid arthritis in older adults can be more difficult than in younger adults because they’re more likely to have other health conditions and be taking other medications.

Rheumatoid arthritis doesn’t have a cure, but treatment can reduce symptoms and slow the progression of the condition. To treat rheumatoid arthritis, doctors often prescribe DMARDs.

DMARDs help reduce symptoms and slow the progression of arthritis by blocking chemicals released by your immune system when it attacks healthy cells. Common DMARDs include:

Methotrexate is often the first DMARD doctors recommend, but you may have to try multiple drugs before you find one that works for you.

Biologic DMARDs are newer treatments for rheumatoid arthritis. They target specific parts of your immune system that create inflammation. They’re usually taken with a DMARD if DMARDs haven’t been effective by themselves.

There are four types of biologics:

  • tumor necrosis factor-α (TNF) inhibitors
  • B-cell inhibitors
  • interleukin inhibitors
  • selective co-stimulation modulators

Several large studies have examined the association between age and treatment response. They found that TNF inhibitors were slightly less, or equally, as effective at reducing disease activity in older adults as in younger individuals.

The results of these studies suggest combinations of TNF inhibitors and methotrexate are more effective at improving symptoms than methotrexate alone.

Rheumatoid arthritis doesn’t have a cure, but visiting your doctor regularly can help you manage your symptoms. Your doctor can help you figure out which drugs are most likely to help ease your symptoms and modify your medications depending on how you respond to them.

A number of lifestyle habits can also help you keep your symptoms under control. Here are some changes you can make that may help ease your discomfort:

If you smoke, consider quitting

Consider quitting smoking if you smoke.

Quitting smoking can be very difficult, but smoking can make your disease worse and contribute to other medical problems. It may also make it more difficult to exercise, which is an important part of a rheumatoid arthritis treatment plan.

Learn more about quitting smoking here.

Get or stay physically active

According to the American College of Rheumatology, long-term studies have found that people with rheumatoid arthritis can benefit from moderate intensity, weight bearing activities. These activities may help decrease bone loss and small joint damage without increasing pain or disease activity.

They recommend incorporating four types of exercises into your program:

  • flexibility exercises to improve or maintain your range of motion
  • strengthening exercises to help strengthen your muscles
  • aerobic exercises to improve your heart, lung, and muscle function
  • body awareness exercises, such as tai chi or yoga, to improve balance and posture

Other lifestyle habits

Other lifestyle habits that may help you keep your arthritis under control include:

  • eating a balanced diet and limiting processed foods, sugar, and other foods that seem to make your symptoms worse
  • scheduling plenty of time for relaxing activities to minimize stress
  • minimizing alcohol intake
  • getting adequate sleep

The exact definition of EORA varies, but it’s generally considered to be rheumatoid arthritis that develops in people over the age of 60 or 65.

EORA treatment comes with additional challenges since older adults are more likely to be taking other medications or have additional health problems than younger people with arthritis.

If you have symptoms you think might be caused by rheumatoid arthritis, it’s important to visit your doctor for a proper evaluation.

Rheumatoid arthritis doesn’t have a cure, but your doctor can help you find the best combination of medications to keep your symptoms under control and prevent further joint damage.

Lifestyle changes like quitting smoking (if you smoke), eating a balanced diet, and exercising regularly may also help you manage your symptoms.