Besonderheiten entzündlich-rheumatischer Erkrankungen im höheren Lebensalter

Zusammenfassung

Polymyalgia rheumatica und Arteriitis temporalis sind typische rheumatische Erkrankungen des höheren Lebensalters. Im Alter tritt zusätzlich eine periphere Arteriitis der großen Gefäße auf. Für diese Erkrankungen werden die notwendige Diagnostik und die zurzeit empfohlene Therapie dargestellt. Im Alter kann sich eine rheumatoide Arthritis erst entwickeln (Late Onset Rheumatoid Arthritis/LORA) oder Menschen mit rheumatoider Arthritis, die in jüngeren Jahren erworben wurde (Young Onset Rheumatoid Arthritis/YORA), sind mit ihrer Erkrankung alt geworden. Zwischen LORA und YORA bestehen im klinischen Bild (schlechterer Funktionsstatus bei LORA), bezüglich der Laborparameter (seltener Rheumafaktoren und ACPA bei LORA) und hinsichtlich des Outcome deutliche Unterschiede. Die Rheumafaktor-negative LORA weist meist einen günstigeren Verlauf auf als die Rheumafaktor-positive. Die radiologische Progression ist bei LORA-Patienten mit positivem Rheumafaktor hingegen stärker ausgeprägt als bei YORA-Patienten. Weiterhin besteht bei einer LORA bei gleicher Krankheitsdauer deutlich häufiger Multimorbidität als bei einer YORA. LORA-Patienten erhalten seltener eine aggressive Therapie, insbesondere ist der Einsatz der Biologika deutlich geringer. Der sich spät manifestierende systemische Lupus erythematodes (LO-SLE) ist bezüglich der Aktivität milder, weist aber deutlich mehr kardiovaskuläre, okuläre und muskuloskelettale Schäden auf als der SLE der früher Erkrankten. Somit ist ein LO-SLE keinesfalls eine benigne Erkrankung. Den Besonderheiten rheumatischer Erkrankungen im Alter ist bei einer älter werdenden Bevölkerung größere Aufmerksamkeit zu schenken.

Abstract

Polymyalgia rheumatica and arteritis temporalis are characteristic rheumatic diseases of advanced age. Concomitantly, peripheral arteritis of large vessels occurs at higher ages. Required diagnostics and current recommendations for the therapy of these diseases are discussed in the present review. Rheumatoid arthritis can develop at advanced age (late onset rheumatoid arthritis/LORA) or patients, whose rheumatoid arthritis commenced at younger age, have grown old with their chronic disease (young onset rheumatoid arthritis/YORA). Considerable differences between LORA and YORA can be found for clinical patterns (worse functional capacity in LORA), for laboratory parameters (lower rheumatoid factor and ACPA in LORA), and for outcome. Rheumatoid factor negative LORA predominantly shows a favourable disease course than one with a positive rheumatoid factor. Radiological progression is more prominent in LORA patients with rheumatoid factor than in the corresponding YORA patients. Furthermore, at the same disease duration LORA patients suffer from more comorbid conditions than YORA patients. LORA patients are treated less aggressively, in particular, biologics are less frequently prescribed. Late onset systemic lupus erythematosus (LO-SLE) shows in general a milder disease activity than SLE of early onset, but is accompanied by more cardiovascular, ocular and musculo-skeletal damage. Therefore LO-SLE is not a benign disease. The specific features of rheumatic diseases at advanced age deserve closer attention in an increasingly older-growing population.

Schlüsselwörter

Polymyalgia rheumatica - Arteriitis temporalis - Late Onset Rheumatoid Arthritis - Late Onset systemischer Lupus erythematodes

Key words

polymyalgia rheumatica - arteritis temporalis - late onset rheumatoid arthritis - late onset systemic lupus erythematosus

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