Rheumatoid arthritis presented in an 89-year-old woman: a case report

Abstract

Introduction and importance: Elderly onset rheumatoid arthritis (EORA) is defined as the onset of rheumatoid arthritis (RA) in individuals over 60 years and presents unique clinical features. Nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs are introduced immediately after the diagnosis is proven. In some cases, biological treatment may be used. We present a case report of EORA in an 89-year-old female. Case presentation: An 89-year-old Syrian female presented with fatigue, fever, generalized arthralgia, and myalgia, with morning stiffness of more than 1 hour for 3 months. On physical examination, she had bilateral joint tenderness and swelling of more than 10 small joints. Laboratory tests revealed anemia and elevated inflammatory markers with a high titer of rheumatoid factor and anti-cytoplasmic citrullinated peptide (anti-CCP). Diagnosis of RA was confirmed, and she was put on prednisolone, methotrexate, and paracetamol. After 6 months, our patient’s clinical examination and laboratory tests had returned to normal. Clinical discussion: About 70% of EORA cases have joint erosions, positive rheumatoid factor, and a worse prognosis, and 25% of EORA cases mimic polymyalgia rheumatic, with a favorable prognosis. EORA has a poor outcome, due to the risk of infection and comorbidities. Conclusion: Our patient presented with symptoms mimicking polymyalgia rheumatica (PMR), so a definitive diagnosis is required between elderly RA and PMR due to their different treatment and complications. Medical professionals should consider a diagnosis of RA in elderly patients, regardless of their age.