This document provides information on a case of a 67-year-old woman with rheumatoid arthritis. It outlines her medical history, including a 2-year history of rheumatoid arthritis affecting multiple joints. On examination, she had decreased range of motion in her shoulders, elbows, wrists, knees and ankles, along with swelling and tenderness. Blood tests showed increased inflammatory markers. X-rays found soft tissue swelling and bone erosion in her hands and knees. She was started on treatment with aspirin, NSAIDs and disease-modifying antirheumatic drugs to manage her elderly-onset rheumatoid arthritis.

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2. Introduction To The Case
Mrs. Kedia is a 67 year-old woman
 2-year history of rheumatoid arthritis
 She was having pains in both ankles with pedal oedema,
more prominent on the left foot, both knees, finger joints,
wrists, lumbar back. The location of pain was shifting.
 She presented with fatigue and dyspnea
 Echocardiography showed a small pericardial effusion
 All complaints worsen in the evening.

3. Social History
She had never smoked and did not drink alcohol. She
lives with her husband and daughter and was active until
her current illness.
Family History
Negative for rheumatoid arthritis or connective tissue
diseases.

4. Physical Examination
 Blood pressure was 150/70 mm Hg with heart rate of
110 bpm. Respiratory rate was 15-20.
 Abdomen was obese
 There were pitting pedal oedema bilaterally.
 Skin had no vasculitic rashes or nodules.
 Musculoskeletal exam showed full range of motion at
the right shoulder; the left shoulder and elbows. Wrists,
knees and ankles had decreased ROM and showed
swelling and tenderness.

5. Pathological Results
Blood Parameter Reference Range Results
Serum Sodium 135 -145 mEq/L 135 mEq/L
Serum Potassium 3.5- 5.0 mEq/L 4.3 mg/dl
Blood Glucose ( PP) < 140 mg/dl 130 mg/dl
Haemoglobin 12.0 – 15.5 gm/dl 6.4 gm/dl
Total Serum Protein 6.0 – 8.3 gm/dl 6 gm/dl
Serum Albumin 3.5 – 5.2 gm/dl 3.7 gm/dl
WBC
Neutrophils
Lymphocytes
Monocytes
4,500 – 11,000 cells/mm3
45 – 70 %
20 – 40 %
2 – 8 %
12,300 cells/mm3
84%
5%
11%
Hematocrit 34.9 – 44.5 % 26.2%
Total Platelet Count 150,000 – 450,000 cells/mm3 415,000 cells/mm3
ESR 0 – 29 mm/hr 131 mm/hr
Serum RF Negative Positive

6. Radiological Examination
Soft tissue
swelling
Marginal
erosion
Joint space
narrowing
Radiograph Hand (postanterior view) Left; Right Radiograph Knee (frontal view) Left; Right

7. Dietary Assessment
 Appetite: Poor
 Low intake of Dairy products
 High Fat intake
 Low intake of Dietary Fibre

8. Pathogenesis of the Disease

9. Causes
Clinical Manifestations
• Environmental
factors
• Immunosenesenc
e
• Pain, Fatigue
• Oedema
• Reduced mobility
• Inflammed Joints
• Muscle wasting
• Rheumatoid
Cachexia
• Genetics

10. Comorbidities
Osteoporosis
Cardiovascular
Diseases
Obesity
Diabetes
GI Problems

11. Phamacotherapy
 Aspirin and NSAIDs
 DMARDs
 Methotrexate
 Sulfasalazine
 Hydroxychloroquine
 Surgery

12. Non-Pharmacological
 Physical Therapy
(Exercise)
 Diet Modification

13. Role of Functional Foods

14. Conclusion
The management of patients with EORA represents a
significant challenge with an increased necessity to
acknowledge the physiological changes of age and
comorbidities. The underlying principles of
management, however, remain the same as the
management of younger onset RA.

15. Bibliography
Journal Reference:
1. Bajocchi, G., et al. "Elderly onset rheumatoid arthritis: clinical aspects.",
Clinical and experimental Rheumatology, 2000; 18(4): 45-49.
2. Brown, J. W., and A. S. Donald, "The onset of rheumatoid arthritis in the
aged.", Journal of the American Geriatrics Society, 1967; 15(10): 873-881.
3. Cecil, R. L., and W. Henry, "Rheumatoid arthritis in the aged.", The American
Journal of Medicine, 1951; 10(4): 439-445.
4. Corrigan, A. B., et al. "Benign rheumatoid arthritis of the aged.", British
Medical Journal, 1974; 1(5905): 442-444.
5. Deal, C. L., et al. "The clinical features of elderly‐onset rheumatoid arthritis. A
comparison with younger‐onset disease of similar duration.", Arthritis &
Rheumatology, 1985; 28(9): 987-994.

16. 6. Dordick, Jack R., "Rheumatoid arthritis in the elderly.", Journal of the
American Geriatrics Society, 1956; 4(6): 588-591.
7. Ehrlich, G. E., W. A. Katz, and S. H. Cohen., "Rheumatoid arthritis in the
aged." Geriatrics 25.2 (1970): 103-113.
8. Groff, Rachel, et al. "Dietary Supplements and Nutritional Approaches Used
for Rheumatoid Arthritis Self-Management.", The Federation of American
Society for Experimental Biology Journal, 2017; 31(1): lb396-lb396.
9. Healey, L. A., "Rheumatoid arthritis in the elderly.", Clinics In Rheumatic
Diseases, 1986; 12(1): 173-179.
10. Ignatavicius, D. D., "Rheumatoid arthritis and the older adult.", Geriatric
Nursing, 2001; 22(3): 139-142.
11. Kavanaugh, A. F., "Rheumatoid arthritis in the elderly: Is it a different
disease?.", The American Journal of Medicine, 1997; 103(6): S40-S48.
12. Lane, Nancy E., et al. "Rheumatoid arthritis and bone mineral density in
elderly women.", Journal of Bone and Mineral Research, 1995; 10(2): 257-
263.

17. 13. Leon, L., et al. "Severe adverse drug reactions to biological disease-modifying
anti-rheumatic drugs in elderly patients with rheumatoid arthritis in clinical
practice.", Clinical and Experimental Rheumatology, 2017.
14. Majithia, V., C. Peel, and S. A. Geraci, "Rheumatoid arthritis in elderly patients.",
Geriatrics, 2009; 64(9).
15. Mavragani, C. P., and H. M. Moutsopoulos, "Rheumatoid arthritis in the elderly.",
Experimental Gerontology, 1999; 34(3): 463-471.
16. McColl, G. J., "Treatment of rheumatoid arthritis in the elderly.", Journal of
Pharmacy Practice and Research, 2005; 35(2): 151-154.
17. Nesher, G., T. L. Moore, and J. Zuckner, "Rheumatoid arthritis in the elderly.",
Journal of the American Geriatrics Society, 1991; 39(3): 284-294.
18. Schaardenburg, D., "Rheumatoid arthritis in the elderly.", Drugs & Aging, 1995;
7(1): 30-37.
19. Serafini, M., and I. Peluso, "Functional Foods for Health: The Interrelated
Antioxidant and Anti-Inflammatory Role of Fruits, Vegetables, Herbs, Spices and
Cocoa in Humans.", Current Pharmaceutical Design, 2016; 22(44): 6701-6715.

18. 20. Tedeschi, S. K., and K. H. Costenbader, "Is there a role for diet in the therapy
of rheumatoid arthritis?.", Current Rheumatology Reports, 2016; 18(5): 20-23.
21. Tutuncu, Z., and A. Kavanaugh, "Rheumatic disease in the elderly: rheumatoid
arthritis.", Clinics in Geriatric Medicine, 2005; 21(3): 513-525.
22. Woodworth, T., V. Ranganath, and D. E. Furst, "Rheumatoid arthritis in the
elderly: recent advances in understanding the pathogenesis, risk factors,
comorbidities and risk–benefit of treatments.", Aging Health, 2013; 9(2): 167-
178.
23. Yazici, Y., and S. A. Paget, "Elderly-onset rheumatoid arthritis.", Rheumatic
Disease Clinics of North America, 2000; 26(3): 517-526.
Book Reference:
Cherukunilli, V. S., and A. Kavanaugh, “Elderly Onset Rheumatoid Arthritis.”,
Geriatric Rheumatology: A Comprehensive Approach, Springer, 2014, pp. 145–
150.

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