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Rheumatoid Arthritis: A disease affecting all age groups

October 4, 2024

Rheumatoid Arthritis: A disease affecting all age groups - featured image

Rheumatoid arthritis (RA) is a chronic inflammatory disorder primarily affecting the joints, but its impact extends beyond physical discomfort. While it is most commonly associated with middle-aged adults, this autoimmune disease affects people across all age groups, from children to the elderly, and presents unique challenges depending on when it occurs. The age of onset can significantly influence the course of the disease, its symptoms, and the type of treatment required.

Early-Onset RA: The most common form

RA typically manifests in adults between the ages of 25 and 45, with women being the most affected. Early-onset RA (RA that occurs before the age of 65) usually involves small joints such as those in the hands and feet, causing pain, swelling, stiffness, and tenderness. The disease is often marked by periods of remission, where symptoms temporarily subside, and flares, where inflammation and discomfort intensify.

Early symptoms may not include visible joint deformities but can present as tenderness, fatigue, and morning stiffness lasting at least 30 minutes. For younger adults, this can be particularly challenging as it may interfere with daily activities, work, and overall quality of life. The physical and emotional toll of managing a chronic condition like RA can be daunting for those in the prime of their careers or raising families.

Elderly-Onset RA: A different experience

When RA develops after the age of 65, it is referred to as elderly-onset rheumatoid arthritis (EORA). Unlike the more common form of RA, EORA often presents differently, affecting large joints such as the shoulders and hips rather than the smaller joints. Older adults may experience more sudden and acute symptoms, and the disease is generally less damaging to bones compared to early-onset RA.

One of the key differences with EORA is that it affects men and women at a more equal rate, while early-onset RA is more common in women. Additionally, elderly individuals are less likely to test positive for certain immune system markers, such as rheumatoid factor, which can make diagnosis more complicated.

Treatment for EORA can also be challenging due to the presence of other age-related health conditions, known as comorbidities, which may limit the use of certain medications. For instance, older individuals are often treated with less potent disease-modifying antirheumatic drugs or biologics due to concerns over side effects. Corticosteroids, commonly used in younger adults, may be avoided in older patients because of their long-term risks, including osteoporosis and an increased risk of infections.

Juvenile Idiopathic Arthritis: RA in children and teenagers

While RA is more prevalent in adults, children are not immune to the disease. Juvenile idiopathic arthritis (JIA) is the most common form of arthritis in children and teenagers. The exact cause of JIA is unknown, though it is believed that a combination of genetic and environmental factors triggers the condition.

There are several subtypes of JIA, each with its own set of symptoms and challenges. These can range from mild joint involvement in oligoarticular JIA, where fewer than five joints are affected, to more severe forms like systemic JIA, which may involve joint pain, rashes, and high fevers.

Managing JIA often requires a careful balance of medication, physical therapy, and sometimes surgery to prevent long-term joint damage and ensure normal growth and development.

Why age of onset matters

The age at which someone develops RA plays a critical role in the management and progression of the disease. Younger adults with RA may be more prone to aggressive forms of the disease and long-term joint damage, especially if the condition is not diagnosed and treated early. Early intervention can slow disease progression and improve long-term outcomes.

In contrast, older adults with EORA may have a milder form of RA but face additional complications due to other health conditions. This makes the treatment of EORA more complex, requiring a tailored approach to minimise side effects while managing symptoms effectively.

Regardless of age, anyone experiencing persistent joint pain, swelling, stiffness, or fatigue should consult a doctor. Early diagnosis is essential in managing RA and preventing long-term damage. Rheumatologists, specialists in arthritis, can help tailor a treatment plan that addresses the specific needs of each individual, taking into account their age, disease severity, and other health conditions.

Dr Amritha Budhoo

Dr Amritha Budhoo

Rheumatologist
Busamed Gateway Private Hospital