Methods Disease course in 173 RA pts with onset in age older than 50 was analysed. It was demonstrated that in 101 pts (M:F = 12:89, median onset 58.6 y/o, median disease duration up to complication – 6.9 yrs, median age of last examination 67.5, median observation period 7.5) the following complications developed: aseptic bone necrosis, secondary amyloidosis, expressed osteoporosis with osteoporotic bone fractures and compression of vertebral bodies.
Results Systemic manifestations (rheumatoid nodes, internal organs lesions, symptoms of serositis) were determined in 36% of pts, rheumatoid factor in 92%. Vasculopathies including livedo reticularis, capillarites and trophic ulcers – in 20% of pts.
Aseptic bone necrosis was found in 40 pts (median observation period 10.2 yrs). Their localization: femoral head and/or tectum of cotyloid cavity in 20 pts, subchondral bones of knee joint – in 14, less frequently in wrist, humerus and elbow joints. Repeated aseptic necroses developed in 31 pts.
31 pts had secondary amyloidosis, median disease duration up to diagnosis – 7.6 yrs. This group of pts demonstrated highest inflammatory activity according to clinical and laboratory data. Observation period of pts with already developed amyloidosis was from 2 to 10.5 yrs. 14 pts out of them died during the period of observation.
Developed osteoporosis and compression of vertebrae were observed in 35 pts (median age of fractures 63.8). Radiodensitometry in all pts demonstrated reduced mineral bone density more than 2.5 CD. Localization of skeletal bones fractures (in 24 pts) was as follows: femoral head in 35% of cases, ribs – in 20%, humerus – in 15%, less frequently radius, pelvic bones, feet. Multiple fractures were observed in 40% of cases.
Compressions of vertebral bodies were found in 19 pts, combinations of osteoporotic fractures and vertebral bodies compression – in 9 pts.
Conclusion Thus, follow-up of elderly pts enabled us to select the group of pts with complicated disease course aggravated the prognosis. Reducing of high inflammatory activity of the disease by active therapy will be positive for the disease course, decrease the risk of complications associated with amyloidosis, with diseases activity, aseptic bone necrosis, osteoporosis.
Preventive measures are recommended to decrease osteoporotic complications from the very beginning of the disease.
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