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Not just pain and morning stiffness duration in the daily experience of patients with polymyalgia rheumatica. Does the rheumatologist listen to all patient-reported outcomes? Reumatologia 2021; 59:200-202. [PMID: 34538948 PMCID: PMC8436807 DOI: 10.5114/reum.2021.106221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/05/2021] [Indexed: 11/17/2022] Open
Abstract
Patient-reported outcomes (PROs) provide a means for patients to communicate with their care teams about their disease. Polymyalgia rheumatica (PMR) is considered to be one of the most common inflammatory rheumatic diseases in older adults. The Visual Analogue Scale (VAS) of pain is the only PRO assessed by the PMR activity score (PMR-AS), which is still the only validated score for monitoring disease activity in patients affected with PMR. Other PROs such as fatigue, sleep disturbances, depressive symptoms, and patient’s perspective related to adverse effects of prednisolone are still unmet needs. This short communication suggests the gerontorheumatological outpatient clinic as an answer.
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Poudel P, Yu J. Geriatric Rheumatology: The Need for a Separate Subspecialty in the Near Future. Cureus 2020; 12:e8474. [PMID: 32642378 PMCID: PMC7336673 DOI: 10.7759/cureus.8474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Rheumatology is a broad specialty in itself, and it involves caring for patients of all age groups. Patients of different age groups have different characteristics and a one-size-fits-all approach is not feasible in catering to their diverse medical needs. The presentation and the manifestations of diseases vary in different age groups. We have pediatric rheumatology as a separate subspecialty where pediatric patients with rheumatological diseases are provided specific care best suited to their needs. However, for older patients, such a separate subspecialty is not widely available in medical practice. Geriatric rheumatology or gerontorheumatology is a branch of rheumatology dealing with older patients with rheumatological diseases. It is high time to consider establishing geriatric rheumatology as a separate subspecialty to provide better care for older patients.
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Affiliation(s)
- Pooja Poudel
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Jianghong Yu
- Rheumatology, State University of New York Upstate Medical University, Syracuse, USA
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Abdoli A, Ardakani HM. Helminth infections and immunosenescence: The friend of my enemy. Exp Gerontol 2020; 133:110852. [PMID: 32007545 DOI: 10.1016/j.exger.2020.110852] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/13/2019] [Accepted: 01/21/2020] [Indexed: 12/14/2022]
Abstract
Age-associated alterations of the immune system, which known as "immunosenescence", is characterized by a decline in innate and adaptive immunity, which leading to increased susceptibility to age-associated diseases, such as infectious diseases, rheumatic disease and malignancies. On the other hand, helminth infections are among the most prevalent infections in older individuals, especially in the nursing homes. Most of helminth infections have minor clinical symptoms and usually causing chronic infections without treatment. Nevertheless, chronic helminthiasis alters immune responses somewhat similar to the immunosenescence. Some similarities also exist between helminth infections and immunosenescence: 1) both of them led to declining the immune responses; 2) undernutrition is a consequence of immunosenescence and helminthiasis; 3) vaccine efficacy declines in aging and individuals with helminth infections; 4) increase incidence and prevalence of infectious diseases in the elder individuals and patients with helminth infections; and 5) both of them promote tumorigenesis. Hence, it is probable that helminth infections in the elderly population can intensify the immunosenescence outcomes due to the synergistic immunoregulatory effects of each of them. It would be suggested that, diagnosis, treatment and prevention of helminth infections should be more considered in older individuals. Also, it would be suggested that helminths or their antigens can be used for investigation of immunosenescence because both of them possess some similarities in immune alterations. Taken together, this review offers new insights into the immunology of aging and helminth infections.
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Affiliation(s)
- Amir Abdoli
- Department of Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran; Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom, Iran; Research Center for Noncommunicable Diseases, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
| | - Hoda Mirzaian Ardakani
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Abstract
The incidence and prevalence of rheumatologic conditions are increasing and the rheumatology workforce must be aware of aging-specific issues. This article reviews specific barriers to understanding the biology of aging and aging-related mechanisms that may underlie development of rheumatologic diseases in older adults. It summarizes gaps in the assessment, outcomes measurement, and treatment of these diseases in this unique population. It also highlights potential solutions to these barriers and suggests possible ways to bridge the gap, from a research and education standpoint, so that clinicians can be better prepared to effectively manage older adults with rheumatologic conditions.
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[Inflammatory rheumatic diseases in the elderly: rheumatoid arthritis and polymyalgia rheumatica]. Internist (Berl) 2012; 53:1020-7. [PMID: 22941456 DOI: 10.1007/s00108-012-3031-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Inflammatory rheumatic diseases with first onset in advanced age have some specific clinical features. Late-onset rheumatoid arthritis and polymyalgia rheumatica/giant cell arteriitis are the most relevant rheumatic diseases among older patients. They are characterized by acute onset, early functional impairment, and difficult differential diagnosis. First-line therapy usually consists of glucocorticoids. During long-term therapy, a spectrum of immunosuppressive agents and biologicals can also be used in elderly patients.
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Gheno R, Cepparo JM, Rosca CE, Cotten A. Musculoskeletal disorders in the elderly. J Clin Imaging Sci 2012; 2:39. [PMID: 22919553 PMCID: PMC3424705 DOI: 10.4103/2156-7514.99151] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 05/03/2012] [Indexed: 11/21/2022] Open
Abstract
Musculoskeletal disorders are among the most common problems affecting the elderly. The resulting loss of mobility and physical independence can be particularly devastating in this population. The aim of this article is to present some of the most frequent musculoskeletal disorders of the elderly, such as fractures, osteoporosis, osteoarthritis, microcrystal disorders, infections, and tumors.
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Affiliation(s)
- Ramon Gheno
- Department of Musculoskeletal Radiology, Centre Hospitalier Régional Universitaire de Lille, Hôpital Roger Salengro, Lille, France
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Wollenhaupt J. [Gerontorheumatology. Aspects of diagnosis, course and therapy of inflammatory rheumatic disease in advanced age]. Z Rheumatol 2009; 68:397-403; quiz 404. [PMID: 19557422 DOI: 10.1007/s00393-009-0476-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Gerontorheumatology deals with the particular features of onset, course and treatment of rheumatic diseases in patients of advanced age. The initial diagnosis of inflammatory rheumatic disease after the age of 60 is hindered by the frequency of non-specific general disease symptoms. The most important gerontorheumatological diseases include rheumatoid arthritis first occurring at advanced age ("late onset rheumatoid arthritis", LORA), rheumatic polymyalgia and giant cell arteritis. Important differential diagnoses in older rheumatology patients are RS3PE syndrome, polyarticular chondrocalcinosis and paraneoplastic rheumatic syndrome. In principle, all specific basic therapeutics, immunosuppressants and biologics can be used for the therapy of these diseases. However, careful dose selection is particularly necessary in the initial phase, taking age-specific limitations in organ function and metabolism into consideration; moreover, close-meshed tolerance tests should be carried out.
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Affiliation(s)
- J Wollenhaupt
- Abteilung Rheumatologie und klinische Immunologie, Schön-Klinik Hamburg-Eilbek, Hamburg.
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8
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Abstract
This article summarizes the different aspects of rheumatoid arthritis and the spectrum of diseases that can present as rheumatoid arthritis in the elderly population. With the ageing of the western population, different forms of inflammatory arthritis' prevalence and incidence are increasing in elderly persons. Difficulties in establishing the diagnosis and introducing new treatment modalities in this patient group pose a great challenge for clinicians. The management of inflammatory arthritis in the elderly requires special consideration in regard to the comorbidities and increased frequency of adverse events. There is substantial need for improving aspects of diagnostic and therapeutic interventions that will reduce the impact of inflammatory arthritis in the growing elderly population.
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Affiliation(s)
- Zuhre Tutuncu
- Division of Rheumatology, Allergy and Immunology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0943, USA
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9
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Abstract
Since the original recognition of these conditions in 1961, a great deal has been learned about the pathogenesis, clinical manifestations, and appropriate treatment of gout and pseudogout, and the role of crystals in osteoarthritis has been further defined. The variable manifestations of crystal-induced arthritis in elderly populations has led to a greater need for proper diagnosis and treatment strategies for these increasingly common forms of arthritis.
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Affiliation(s)
- Christopher M Wise
- Internal Medicine, Division of Rheumatology, Allergy, and Immunology, Medical College of Virginia, Virginia Commonwealth University Health System, 417 North 11th Street, Box 980647, Richmond, VA 23298, USA.
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10
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Abstract
Patients who visit the emergency department often have complaints of joint and limb pain. The differential diagnosis, clinical presentation, and treatment choices can be vastly different in the young- or middle-aged population compared with the elderly population, and the concerns of each group must be addressed. The emergency physician is in a unique position in that they are frequently the first to see these individuals and have the opportunity to intervene before permanent disability ensues. Some of the more common etiologies of atraumatic joint and limb pain, including crystal deposition diseases such as gout and pseudogout, osteoarthritis, septic arthritis, and inflammatory arthritides such as rheumatoid arthritis will be addressed in this article. In addition,several arthritides specific to the elderly population such as poly-myalgia rheumatica and associated giant cell arteritis will be covered. Finally a discussion of cervical and lumbar disc disease, as well as gait disorders, and their impact on the elderly, will be presented.
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Affiliation(s)
- Lori Harrington
- Department of Emergency Medicine, Boston Medical Center, Dowling 1 South, 1 Boston Medical Center Place, Boston, MA 02118, USA
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11
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Abstract
Gout is a common form of inflammatory arthritis that has been managed primarily in general medical practices for centuries. It appears that there has been an increasing prevalence of gout over the past decades, implying a growing public health burden. Accurate diagnosis and recognition of the various stages and manifestations of gout enable realistic goal setting for management. Recent evidence suggests new risk factors and potentially refutes others. Management of gout requires characterising and modifying risk factors and associated disorders, and commonly initiating drug therapy. Pharmacotherapy of gout includes the management of acute flares with anti-inflammatory agents such as NSAIDs and glucocorticoids and long-term treatment with urate-lowering drugs. Although pharmacotherapy is generally safe and effective, there are caveats and limitations to all gout therapies. Patient non-adherence and errors with the use of drugs for gout treatment are important factors leading to medical failures. With early intervention, careful monitoring and patient education, gout is a condition that can be managed very effectively. The advent of new drugs (such as febuxostat and urate oxidase [uricase]) and enhanced understanding of the pathogenesis of gout continue to improve our therapeutic options, particularly in a subset of patients with refractory disease and those who are intolerant to currently available medications.
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Affiliation(s)
- Gim Gee Teng
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama 35294-3296, USA
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Abstract
This review summarizes the different aspects of rheumatoid arthritis and the spectrum of diseases that can present as rheumatoid arthritis-like arthritis in the elderly population. With the aging of Western population, different forms of inflammatory arthritis' prevalence and incidence are increasing in the elderly persons. Difficulties in establishing the diagnosis and introducing new treatment modalities in this patient group poses a great challenge for the clinicians. The management of inflammatory arthritis in the elderly requires special consideration in regard to the comorbidities and increased frequency of adverse events. There is definitely a substantial need for improving different aspects of diagnostic and therapeutic interventions that will reduce the impact of inflammatory arthritis in the growing elderly population.
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Affiliation(s)
- Zuhre Tutuncu
- Division of Rheumatology, Allergy and Immunology, University of California-San Diego, La Jolla, CA 92093-0943, USA.
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13
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Abstract
Since the original descriptions of the involvement of crystals in arthritis, our understanding of the clinical syndromes of gout and pseudogout, and the role of basic calcium crystals in arthritis has increased. Gout is usually considered an affliction confined to middle-aged men, but has an increasing prevalence in older populations, with unique and often atypical features. Calcium pyrophosphate dihydrate crystal deposition disease is common in elderly patients. The diagnosis of both of these common forms of arthritis and the need to individualize therapy in patients with other medical problems remain important clinical challenges to the practicing physician.
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Affiliation(s)
- Christopher M Wise
- Internal Medicine Division of Rheumatology, Allergy, and Immunology, Medical College of Virginia, Virginia Commonwealth University Health System, Richmond, VA 23298, USA.
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van Lankveld W, Franssen M, van Kessel M, van de Putte L. Gerontorheumatologic outpatient service. Arthritis Care Res (Hoboken) 2004; 51:299-301. [PMID: 15077277 DOI: 10.1002/art.20230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Acute arthritis in critically ill patients may be caused by local or systemic infection, by a flare of chronic joint disease such as rheumatoid or crystal-associated arthritis, or by less common entities such as hemarthrosis. Diagnosis requires analysis of synovial fluid, and appropriate treatment is based on its findings. Prompt diagnosis and treatment are usually necessary to prevent the significant morbidity associated with these conditions.
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Affiliation(s)
- Jaya M Raj
- Mayo Graduate School of Medicine, 200 1st Street SW Siebens Building #5, Rochester, MN 55905, USA.
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Abstract
The understanding of the clinical syndromes of gout and pseudogout, and the role of basic calcium crystals in arthritis has increased since the original descriptions of the involvement of crystals in arthritis. Gout is usually considered an affliction confined to middle aged males but has an increasing prevalence in older populations, with unique and often atypical features. Calcium pyrophosphate dihydrate crystal deposition disease is common in elderly patients. The diagnosis of these common forms of arthritis and the need to individualize therapy in patients with other medical problems remain important clinical challenges to the practicing physician.
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Affiliation(s)
- C A Agudelo
- Section of Rheumatology, Emory University School of Medicine, Decatur, Georgia, USA
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Abstract
PURPOSE We define the differences between geriatric patients with urinary stone disease compared to a younger cohort. MATERIALS AND METHODS A data base, including serum biochemical profiles, 24-hour urinalyses and standardized questionnaires, was retrospectively evaluated from more than 6,000 consecutive patients with urinary stone disease. RESULTS Geriatric stone formers comprised 12% (721) of all stone patients. Two-thirds of these elderly patients had aberrant urinary values and 29% had isolated hypocitraturia compared to 17% in the younger group. Of geriatric stone forming patients 76% had recurrent urinary stones (mean 3.5 stone episodes), which was similar to the younger comparable group (77%, mean 3.3 stone episodes). The severity of urinary stone disease was similar between the 2 groups based on the need for urological intervention. Geriatric stone patients, in general, experienced the first stone episode later in life (after age 50 years) compared with younger patients. Elderly patients had an increased incidence of uric acid stones, but had a similar incidence of struvite calculi. Geriatric stone patients underwent parathyroid surgery more frequently (2.7 versus 0.7%). Geriatric stone forming patients rarely had renal failure. CONCLUSIONS The incidence, recurrence and severity of recurrent urinary stone disease were similar between geriatric and younger stone forming patients. Geriatric stone patients had an increased incidence of isolated hypocitraturia, uric acid calculi and previous parathyroidectomy. The geriatric stone population is not merely an extension of younger stone forming patients presenting at an older age. Rather, geriatric patients commonly experience the first symptomatic stone episode later in life.
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Affiliation(s)
- D L Gentle
- Department of Urology, University of California School of Medicine, San Francisco 94143-0738, USA
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PULMONARY INVOLVEMENT IN COMMON RHEUMATOLOGIC DISEASES IN THE ELDERLY. Immunol Allergy Clin North Am 1997. [DOI: 10.1016/s0889-8561(05)70339-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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