Geriatric Rheumatology: A Comprehensive Approach PDF
Preview Geriatric Rheumatology: A Comprehensive Approach
Geriatric Rheumatology wwwwwwwwwwwwwwwwwwwwww Yuri Nakasato • Raymond L. Yung Editors Geriatric Rheumatology A Comprehensive Approach Editors Yuri Nakasato Raymond L. Yung Sanford Health Systems Department of Internal Medicine Fargo, ND, USA University of Michigan [email protected] Ann Arbor, Michigan, USA [email protected] ISBN 978-1-4419-5791-7 e-ISBN 978-1-4419-5792-4 DOI 10.1007/978-1-4419-5792-4 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2011928680 © Springer Science+Business Media, LLC 2011 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. 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Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Preface It is our pleasure to introduce an exciting new textbook that provides a much-needed and different perspective on rheumatology. Our outstanding contributors have put in a lot of effort and thought delving into the aging process per se, the older population, and how they affect the future of rheumatology. Let face it, our patient population is aging. Although patients over 65 years of age still compose around 15% of the total population, they are consuming about 50% of rheumatology resources. Innovative ways of doing research, patient care, education, and policy need to be addressed in order to improve quality of care, patient satisfaction, and the safety of our older population. Multi-disciplinary teams have always been the hallmark of geriatrics but they are cost- prohibitive in times of healthcare system reforms and social changes. As the age of retirement increases, it is crucial to keep the older patient with rheumatic conditions functional or – even better – active in the work force. We invite you to continue thinking in new terms and adapt to their needs, considering new models that are economically sustainable. Patients with rheumatic diseases are getting older and attaining closer-to-normal popula- tion life expectancies. On the other hand, patients without rheumatic diseases are living longer too, thanks to improved therapies and advances in public health. This allows the development of a variety of elderly onset rheumatic diseases with often atypical presentations. Furthermore, immunosenescence complicates the geriatric rheumatology panorama with a combination of suppressed immune responses, low-grade chronic inflammatory reactions (also called inflamm- aging), and clinically non-significant autoantibodies that raise questions and puzzle even the more reputable experts. Moreover, uncontrolled inflammatory autoimmune conditions accele- rate atherosclerosis and may give the false impression of an equally accelerated intrinsic aging, since morbidity and aging both decrease the physiological reserves. Older patients present to rheumatologists with a milieu of baseline co-morbidities. This fact has highlighted the need to group rheumatologic with non-rheumatologic diseases such as diabetes, hypertension, atrial fibrillation, and cardiovascular diseases in the future. For exam- ple, it is starkly different to treat a patient with polymyalgia rheumatica and uncontrolled diabetes than a patient without diabetes. Until older rheumatic disease patients with multiple co-morbid conditions are included in clinical trials, it will be impossible to have high quality evidence-based treatment guidelines for the older arthritis patients. Different specialists have created a pharmacological vicious cycle by prescribing increas- ingly more medications; once the number of medications reaches the double digits, sophisti- cated drug inventory management techniques may be required. Older patients are known to have voluntary or involuntary compliance problems; drug cost, dementia, and visual problems are the main issues. Medications are justified but at times, they are not withdrawn promptly when the acute problem subsides, creating a list of necessary and unnecessary medications. As a consequence, the cycle is closed by a new round of problems attributed to medications, such as peptic ulcer disease (due to nonsteroidal anti-inflammatory agents [NSAIDs]), gas- trointestinal bleeding (due to medications interacting with Coumadin), falls with fractures v vi Preface (due to narcotics or psychotropic medications), infections (due to immunosuppressive therapy), or heart diseases (related to NSAIDs or anti-TNF [tumor necrosis factor] agents). The cache of biological therapies available to rheumatologists is ever expanding. Simultaneously, they are creating reactivation of old diseases (such as fungal invasive infec- tions and tuberculosis or herpes zoster), malignancies such as lymphoma, or new autoimmune diseases (drug-induced lupus). Surveillance, vaccination, and early diagnosis are becoming the rule rather than the exception. The question rheumatologists constantly face is whether to be aggressive or more conservative when treating the older patient. The focus of elder care is on cure (if possible), improvement in quality of life, rehabilitation, and palliative care. Some older patients and their families are coming to the clinic with new expectations of cure as they are better-informed, but they may also be confused due to the overwhelming amount of unfiltered internet information. Ultrasound technology controlled by rheumatologists is already at full swing in Europe, and it is becoming the new joint-stethoscope for rheumatologists around the world. Providers are enhancing their physical examination skills and becoming more precise and efficient doing procedures. Older patients with dementia, or those unable to talk due to hospitalization or delirium, can be examined by use of ultrasound for synovitis or fluid in unexpected areas for diagnostic arthrocentesis to allow prompt therapy and prevent unnecessary treatments. The health-care landscape is rapidly changing and the average age of rheumatologists is also rising. Much of rheumatology practice takes place in the outpatient setting. Instead of see- ing the patient in the hospital for a secondary consultation, patients may be discharged home with the expectation that they will be seen promptly in the rheumatology clinic. While Internal Medicine is undergoing a hospitalist movement, primary care overall is shifting to advanced practice providers, increasing demand for rheumatology consultations. The older patient is trapped in the midst of all these changes; our book Geriatric Rheumatology: A Comprehensive Approach encourages you to think from the older patient’s perspective. Fargo, ND Yuri Nakasato Ann Arbor, MI Raymond L. Yung Contents Part I Aging and Comorbidity in Rheumatology 1 The Immune System in Aging ................................................................................. 3 Anjali Desai and Raymond L. Yung 2 Bone Aging ................................................................................................................ 11 Arthur N. Lau and Jonathan D. Adachi 3 Atherosclerosis in the Rheumatic Diseases: Compounding the Age Risk .......... 17 Naoto Yokogawa and Joan M. Von Feldt 4 Neuropsychiatric Manifestations of Rheumatic Diseases in the Elderly ............ 27 Jamal A. Mikdashi 5 Tuberculosis and Rheumatoid Arthritis in the Elderly ........................................ 35 Eduardo M. Acevedo-Vásquez, Darío Ponce de León, and Rocío V. Gamboa-Cárdenas 6 Widespread Pain in Older Adults ........................................................................... 45 Cheryl D. Bernstein, Jordan F. Karp, and Debra K. Weiner Part II Multidisciplinary Approach to Geriatric Rheumatology 7 Pharmacotherapy Considerations Unique to the Older Patient .......................... 59 Keith A. Swanson and Mark A. Stratton 8 Rheumatic Disease in the Nursing Home Patient ................................................. 73 Joanne Sandberg-Cook 9 Post-acute Care for Rheumatologists ..................................................................... 79 Deborah W. Robin 10 The Gerontorheumatology Outpatient Service: Toward an International Classification of Function-Based Health Care Provision for the Elderly with Musculoskeletal Conditions ............................................................................ 85 Wim Van Lankveld, Josien Goossens, and Marcel Franssen 11 Health Policy, Public Health, and Arthritis Among Older Adults ...................... 93 Kristina A. Theis, Debra R. Lubar, and Teresa J. Brady 12 Physical Therapy Management of Select Rheumatic Conditions in Older Adults ......................................................................................................... 101 Maura Daly Iversen and Madhuri K. Kale vii viii Contents 13 Arthrocentesis in the Elderly .................................................................................. 113 Ahmed S. Zayat and Richard J. Wakefield 14 Physical Activity in Older Adults with Arthritis................................................... 125 Dorothy D. Dunlop, Pamela Semanik, and Rowland W. Chang Part III Rheumatic Diseases in the Elderly 15 Systemic Lupus Erythematosus in Elderly Populations ....................................... 135 Ana M. Bertoli, Guillermo J. Pons-Estel, Paula I. Burgos, and Graciela S. Alarcón 16 Elderly Onset Rheumatoid Arthritis ...................................................................... 145 Venkata Sri Cherukumilli and Arthur Kavanaugh 17 Disease-Modifying Antirheumatic Drug Use in Older Rheumatoid Arthritis Patients ................................................................................ 151 Sogol S. Amjadi, Veena K. Ranganath, and Daniel E. Furst 18 Epidemiology, Risk Factors, and Aging of Osteoarthritis .................................... 173 Crisostomo Bialog and Anthony M. Reginato 19 Osteoarthritis in the Elderly Population ................................................................ 187 Roy D. Altman 20 Medium- and Small-Vessel Vasculitis ..................................................................... 197 Rafael G. Grau 21 Management of Geriatric Gout .............................................................................. 209 Lan X. Chen 22 Calcium-Containing Crystal-Associated Arthropathies in the Elderly Population ......................................................................................... 213 Elisabeth B. Matson and Anthony M. Reginato 23 Polymyalgia Rheumatica and Giant Cell Arteritis in the Elderly ....................... 225 Wolfgang A. Schmidt 24 Antiphospholipid Syndrome in the Older Population .......................................... 231 Silvia S. Pierangeli, Alan M. Seif, and Emilio B. González 25 Osteoporosis and Metabolic Bone Diseases of the Elderly ................................... 241 Lora Giangregorio and Alexandra Papaioannou 26 Infectious Arthritis in the Elderly .......................................................................... 251 Nicole Melendez and Luis R. Espinoza 27 Sarcopenia and Myopathies in the Elderly ............................................................ 259 Kenneth S. O’Rourke 28 Scleroderma in the Elderly Population .................................................................. 275 Rebecca L. Manno and Fredrick M. Wigley 29 Sjögren’s Syndrome in the Elderly ......................................................................... 287 Raymond L. Yung and Sheeja Francis Index .................................................................................................................................. 293 Contributors Eduardo M. Acevedo-Vásquez, MD Professor, Department of Rheumatology, School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru Jonathan D. Adachi, BSc, MD, FRCP(C) Professor, Department of Medicine, McMaster University/St. Joseph’s Healthcare Hamilton, Ontario, Canada Graciela S. Alarcón, MD, MPH Jane Knight Low Chair of Medicine in Rheumatology (Emeritus), Department of Medicine, Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, Alabama, USA Roy D. Altman, MD Professor of Medicine, Department of Medicine, Division of Rheumatology, University of California Los Angeles, Los Angeles, California, USA Sogol S. Amjadi, MS Clinical Research Assistant, Division of Rheumatology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA Cheryl D. Bernstein, MD Assistant Professor, Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Ana M. Bertoli, MD Staff Member, Instituto Reumatológico Strusberg, Córdoba, Argentina Crisostomo Bialog, MD Rheumatology Fellow, Department of Rheumatology, Brown University, Providence, Rhode Island, USA Teresa J. Brady, PhD Senior Behavioral Scientist, Arthritis Program, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA Paula I. Burgos, MD Instructor, Department of Clinical Immunology and Rheumatology, School of Medicine, Pontifica Universidad Católica de Chile, Santiago, Chile Rowland W. Chang, BA, MD, MPH Professor of Preventive Medicine, Medicine, and Physical Medicine and Rehabilitation; Director, MPH Program; Senior Faculty Fellow, Institute Healthcare Studies; Director, Multidisciplinary Clinical Research Center in Rheumatology’s Methodology and Data Management Core Unit; Northwestern University Feinberg School of Medicine; Attending Physician, Co-Director, Arthritis Program, Rehabilitation Institute of Chicago; Department of Preventative Medicine, Northwestern University, Chicago, Illinois, USA ix
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