Rheumatoid arthritis (RA) is an autoimmune disease that occurs when the body’s immune system mistakenly attacks healthy cells within the joints. It can begin at any age, but the chance of onset is highest in older adults.

Rheumatoid arthritis (RA) causes inflammation and symptoms such as joint pain, swelling, and stiffness.

RA that develops in older age is sometimes known as elderly onset rheumatoid arthritis (EORA).

This article examines EORA’s symptoms, diagnosis, treatment, and outlook.

Estimates indicate that 17 million people in the United States have RA. EORA is a form of RA that begins later in life. Although RA generally occurs most often in people who are in their 50s, healthcare professionals will typically classify the condition as EORA if the person develops symptoms over the age of 65.

In RA, the tissue lining the joints thickens, resulting in swelling and pain. As time passes, the cartilage and bone can also become damaged. The signs that may indicate RA include:

  • pain, aching, tenderness, swelling, or stiffness in more than one joint
  • the same symptoms on both sides of the body, such as in both shoulders or knees
  • unintentional weight loss
  • fatigue
  • weakness
  • fever

But, researchers estimate that EORA accounts for approximately 10% to 33% of all people with RA, and there can be differences between EORA and young-onset rheumatoid arthritis (YORA). According to research, EORA is more likely to:

  • Affect both sexes more evenly, while YORA is more likely to occur in women.
  • Affect large joints, such as the shoulders, more frequently than YORA.
  • Occur with other conditions or comorbidities, which can make RA more challenging to treat.
  • Have similarities with polymyalgia rheumatica (PMR), which can make dagnosing EORA more challenging for doctors.

Early diagnosis and treatment are key to successful RA management because joint damage is irreversible once it takes place.

However, doctors may underdiagnose RA in older adults because it can mimic other conditions, such as PMR. Additionally, although some tests can suggest RA, they are not always conclusive.

Doctors can diagnose RA by:

  • taking the person’s medical history
  • performing a physical exam of the affected joints
  • requesting blood tests for biomarkers of autoimmunity, such as rheumatoid factor (RF) and anticitrullinated protein antibody (ACPA)
  • recommending PET or CT scans

The presence of RF in the blood of older adults does not always indicate an autoimmune disease. About 10% of people ages 60 years who do not have RA have RF in their blood. Additionally, it is possible to have RA even if the blood tests for RF and ACPA are negative. This is known as seronegative EORA.

It is important to treat EORA immediately. Most of the same drugs that doctors use to treat YORA also work for EORA.

A doctor may suggest:

Older adults can be more susceptible to steroid-related side effects, including diabetes, osteoporosis, and hypertension. Due to this, doctors should only use prednisone to lower inflammation quickly before trying other options.

If someone has other conditions that prevent them from taking steroids or other RA drugs, healthcare professionals can find alternative treatment methods.

In addition to medication, older adults can consider the following to help manage and reduce their symptoms:

  • Staying physically active: Stretching and moderate exercise are essential to managing EORA. However, people with RA may find this challenging if they have joint pain. To participate in safe activities, people may find it helpful to consult a physical therapist or join a disability-friendly exercise class.
  • Resting the joints: Although exercise is beneficial, it is also important to rest the RA-affected joints so they have a chance to recover. Some people may wish to use supportive splints for inflamed joints. It is also possible to purchase devices that make using the affected joint easier, such as door handle extenders and electric can openers.
  • Stopping smoking: Tobacco smoke makes RA worse. It can also make it more challenging to stay physically active, which makes managing RA more difficult.
  • Maintaining a moderate weight: Excess body weight can place additional pressure on the joints.
  • Joining an RA management class: Attending these classes can help people learn how to manage and control their symptoms and improve their quality of life. The CDC lists self-management programs on its website.
  • Improving sleep and mental health: A 2024 study found that nearly 63.3% of participants living with RA had difficulty with sleep. In addition, about 26% to 46% and 14.8% to 34.2% of people with RA experience anxiety and depression, respectively. Addressing both sleep and mood difficulties can help a person manage their condition. People may wish to discuss ways of doing this with a doctor and a mental health professional.
  • Adjusting the home environment: Temperature and weather can affect RA symptoms. If a person notices that cold, hot, or humid weather affects their symptoms, they may be able to make changes to the home accordingly. For example, if cold weather worsens RA, a person can take steps to ensure it is warm indoors.

People with EORA generally have a less optimistic outlook than those with YORA, as EORA tends to cause more disability. It also has lower remission rates and can shorten a person’s life span. However, there have been advancements in the understanding and treatment of the disease.

Early diagnosis leads to a better outlook. For this reason, anyone with symptoms that could indicate RA should speak with a doctor as soon as possible. Keeping a symptom diary and preparing a list of questions ahead of time can help.

Treating comorbidities may also reduce the impact of EORA. A single-center 2020 study found that treating conditions such as diabetes or interstitial lung disease had a positive effect on older adults with RA.

According to the United Kingdom’s National Health Service (NHS), the exact cause of RA is unknown, but it’s believed to stem from genetic and environmental factors. Sudden-onset RA does occur, but it is less common than a gradual onset.

Research suggests it is possible to develop RA after the age of 80.

RA progresses in four stages: early, moderate, severe, and end stage. Each phase is characterized by worsening joint damage and growing functional limitations.

EORA is a type of inflammatory arthritis caused by the body’s immune system attacking the joints, leading to pain, swelling, and stiffness. In older adults, it tends to affect larger joints, such as the shoulders. It also causes various other symptoms, including fatigue and weight loss.

Anyone who develops the symptoms of RA should speak with a doctor as soon as possible because an early diagnosis typically leads to the best outcomes.