COMMON RHEUMATOLOGIC DISEASES IN ELDERLY PATIENTS

Objective: To review common rheumatologic disorders that affect elderl y patients and emphasize the unique diagnostic and therapeutic challen ges inherent in the management of rheumatologic diseases in this age-g roup, Design: We summarize our approach to treatment and management of specific rheumatologic problems in geriatric patients and discuss per tinent studies from the literature, Results: Among the spectrum of rhe umatologic disorders frequently encountered in the elderly population are polymyalgia rheumatica, fibromyalgia, giant cell arteritis, crysta lline arthropathies (gout and pseudogout), and degenerative joint dise ase, The initial manifestations of these rheumatologic diseases in eld erly patients may differ from the typical findings in younger patients , Geriatric patients may have nonspecific complaints, a decline in phy sical function, or even confusion, Because of physiologic changes asso ciated with aging and a decrease in functional reserves, elderly patie nts are susceptible to adverse effects of pharmacologic therapy (inclu ding nonsteroidal anti-inflammatory medications, corticosteroids, narc otic analgesics, allopurinol, and colchicine), Clinicians should be al ert for such problems as hepatotoxicity and occult gastrointestinal bl ood loss, Comorbid conditions such as cardiovascular disease and cogni tive impairment may complicate management strategies and may limit the goals of both surgical intervention and rehabilitation programs in el derly patients, Conclusion: Rheumatologic disorders in geriatric patie nts pose special challenges to primary-care physicians, In the selecti on of optimal pharmacologic and nonpharmacologic therapeutic modalitie s, clinicians should focus on maintaining or improving the patient's q uality of life and level of independent function.