The two most common forms of crystal-induced arthritis among older adults are gout and calcium pyrophosphate dihydrate (CPPD) deposition disease. Gout in older adults has unique clinical features. The new case incidence is the same in males and females over age 60. Upper limb and polyarticular involvement are not unusual. CPPD deposition disease may present as asymptomatic chondrocalcinosis on radiographs and symptomatically as pseudogout, pseudo–rheumatoid arthritis, or pseudo-osteoarthritis. Other crystals may cause periarthritis or arthritis. Management of crystal-induced arthritis among older adults requires special considerations due to comorbid conditions and concomitant medications. Nonsteroidal anti-inflammatory drugs may be contraindicated. Steroids taken either orally or intra-articularly are often an alternative.
Key words: gout, chondrocalcinosis, pseudogout, pseudo–rheumatoid arthritis, pseudo-osteoarthritis.
The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme.htm
Musculoskeletal inflammatory conditions in the older patient cover the spectrum of those conditions affecting all age groups to those that are associated with advanced age. Polymyalgia rheumatica and pseudogout are two conditions which are seen predominately in older adults. While gout occurs more often in males in younger patients, both genders may present in the older population. Myositis in an older patient is more likely to be associated with neoplasia, so a search for common tumours should comprise part of the workup of that patient. Hypertrophic pulmonary osteoarthropathy associated with malignancy should be considered in the older patient who presents with arthritis, long bone pain, and clubbing. Osteoarthritis is by far the most common arthritis in the older population. It is important to identify those patients who have clinical features of inflammation in order to provide that subgroup with appropriate anti-inflammatory treatment.
Key words: polymyalgia rheumatica, pseudogout, synovitis, osteoarthritis, myositis.
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