Abstract
The number of elderly patients with rheumatoid arthritis (RA) has been increasing as a result of Japan's aging society. Elderly patients with RA can be divided into those who grow old after the disease onset of average age and those prevail RA at an older age than normal. Elderly RA should be differentiated from polymyalgia rheumatica, remitting seronegative symmetrical synovitis with pitting edema, and microscopic polyangiitis. Since elderly RA patients are likely to have many concurrent diseases such as renal insufficiency, diabetes mellitus, and old tuberculosis, surgical procedures as well as the appropriate dosages of nonsteroidal anti-inflammatory drugs, disease modifying anti-rheumatic drugs, or biological agents should be carefully determined. In particular, attention should be paid to carefully monitor the patient's renal function since elderly RA patients often have a normal serum creatinine level despite of impaired renal function due to low muscular volume. Cystatin C may be a good marker of renal function since its blood level is not affected by sex and muscular volume. Mizoribine might be a good option for elderly RA patients with mild renal dysfunction since it dose not increase side effects and possibly effective due to the elevation of the concentration in the blood. Steroid hormones should be used in combination with drugs for the treatment of osteoporosis such as bisphosphonates, vitamin D3, and Vitamin K2. Vitamin D3 should be used while monitoring the urinary calcium excretion levels to prevent the occurrence of renal stones. The most important point when treating elderly RA patients is that a sufficient degree of cooperation is obtained by both orthopedic surgeons and internal physicians.
