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Rheumatology in the Elderly
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Osteoarthritis
Prioritize non-pharmacological therapy, adjust drugs for renal function, monitor for side effects.
Rheumatoid arthritis
Consider age-related changes in drug metabolism, monitor for infections due to immunosuppression, emphasize low-impact exercises.
Gout
Use lower starting doses of medications, assess for comorbid conditions, encourage hydration.
Polymyalgia rheumatica
High-dose corticosteroids are the mainstay treatment, monitor for giant cell arteritis, consider long-term side effects of steroids.
Osteoporosis
Focus on fall prevention, ensure adequate calcium and vitamin D, monitor bone density.
Fibromyalgia
Pain management should be tailored, consider sleep disturbances, engage in gentle aerobic exercises.
Systemic lupus erythematosus (SLE)
Assess organ system involvement, adapt medications to reduce side effects, close monitoring for comorbidities.
Sjogren's syndrome
Emphasize eye and oral care, monitor for lymphoma, adjust therapies for systemic involvement.
Psoriatic arthritis
Careful with systemic treatments due to comorbidities, monitor for dermatologic and joint manifestations, tailor exercise programs.
Vasculitis
Be vigilant for systemic symptoms, use corticosteroids and immunosuppressants cautiously, screen for infections.
Septic arthritis
Early diagnosis and treatment are critical, consider atypical organisms in the elderly, ensure appropriate antibiotic therapy.
Adult-onset Still's disease
Be aware of atypical presentation, manage systemic symptoms, monitor for complications like macrophage activation syndrome.
Calcium pyrophosphate deposition disease (CPPD)
Identify crystal deposition via imaging, use NSAIDs cautiously, consider underlying metabolic disorders.
Ankylosing spondylitis
Physical therapy and exercise are key, use TNF inhibitors cautiously, focus on maintaining spinal mobility.
Giant cell arteritis
High-dose steroids are the first line of treatment, monitor for visual symptoms, consider temporal artery biopsy for diagnosis.
Tendinitis and bursitis
Use conservative management first, consider local corticosteroid injections with caution, emphasize gradual return to activity.
Relapsing polychondritis
Steroid-sparing agents may be required, watch for airway involvement, manage pain and inflammation.
Sarcopenia
Implement resistance and balance exercises, ensure adequate protein intake, assess for vitamin D deficiency.
Osteomalacia
Look for causes of vitamin D deficiency, correct with appropriate supplementation, and monitor for bone pain and muscle weakness.
Paget's disease of bone
Diagnose with alkaline phosphatase levels and imaging, treat with bisphosphonates if symptomatic, monitor for hearing loss and osteoarthritis.
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