Abstract

With 30% of rheumatoid arthritis (RA) sufferers over the age of 60 it is important to be aware of the variety of presentations, prognosis and treatments available. Differentiation from polymyalgia is vital, particularly if older patients are to benefit from the disease modifying drugs as RA occurring in later life is likely to be more severe and less well tolerated. Steroids are a good bridge until disease modifying antirheumatic drug (DMARD) therapy is at therapeutic levels. Combination DMARD therapy is potentially the most effective treatment yet there is limited data on its use in an older population. In this article we review the variety of presentations, important differentials and evidence behind treatment.