Rheumatoid arthritis with onset in old age: From immune aging to the organization of specialized care

The onset of rheumatoid arthritis (RA) in the old age differs from that at an earlier age in terms of severity of course, disease activity, response to therapy, and outcomes, which has led to the suggestion of a specific phenotype of RA with onset in old age. However, the difficulties of managing the elderly patient with RA are not only due to the specific features of the main disease, but also due to other factors: multimorbidity, polypharmacy and geriatric syndromes (sarcopenia, senile asthenia, falls, cognitive deficit, incontinence). Such a combination of clinical conditions significantly exacerbates not only the course of the main disease, but also complicates the decision-making process regarding the optimal tactics for the overall patient management. The existing difficulties of managing elderly patients with RA have not yet led to the formation of a generally accepted approach; however, to solve this problem, a comprehensive geriatric assessment (CGA) has been proposed. CGA is a diagnostic process aimed at evaluating the physical, psycho-emotional status, functional abilities and social problems of the elderly person in order to keep their independence, general functioning, as well as to optimize medical and social care.