Rheumatoid Arthritis and Aging: Managing Challenges and Maintaining Health

Getting older presents challenges for everyone, and having rheumatoid arthritis (RA) can add several layers of complications. Most people lose some strength and flexibility with age, but people with RA can develop serious limitations because of damaged and painful joints. And while many people develop chronic conditions as they age, like heart disease or osteoporosis, people with RA are at greater risk of these, and they can be more difficult to manage while also treating RA. Because RA can cause issues throughout your body, it’s essential to stay on top of the symptoms, have a multidisciplinary healthcare team, and to make adaptations to your lifestyle that can make your life easier.

Common Physical Challenges of Aging and RA

Muscle Loss

Everyone loses muscle mass and strength with age, but people with RA lose more. One study found that the loss of lean muscle mass was three times higher in women with RA than in women who don’t have RA [1]. That’s largely because the joint pain, swelling, and stiffness associated with RA discourage people from exercising and doing everyday activities that help keep muscles strong.

Osteoporosis

People with RA may have double the risk of osteoporosis [1]. The system-wide inflammation associated with RA activates osteoclasts, bone cells that break down bone tissue, which can lead to bone loss. Long term use of corticosteroids is also a risk factor for osteoporosis [1].

Osteoarthritis

Most people over 60 have some osteoarthritis [3], and people with rheumatoid arthritis are at even higher risk of developing it than those who don’t have RA [1]. That means you may have joint pain caused by either form of arthritis.

RA Comorbidities

“Rheumatoid arthritis is a systemic disease. it’s inflammation of the entire body,” says Jonathan Greer, MD, a clinical professor of biomedical sciences at the University of Miami. That inflammation can cause damage to other systems and can increase the risk and severity of many age-related conditions. These include:

Cardiovascular Disease

The risk for serious cardiovascular events in people with RA is two to three times higher than the general population [1]. Other risk factors for heart disease tend to be more common in people with RA, like hypertension, smoking, diabetes, and obesity.

Lung Disease

Inflammation can cause scarring of lung tissue, leading to a complication called interstitial lung disease [1]. People with RA are also at increased risk for pulmonary nodules, buildup of fluid in the lungs, and bronchiectasis (damage to the airways).

Kidney Disease

Both the inflammation and long-term use of certain medications used to treat RA, like NSAIDs, can damage the kidneys [1].

Cognitive Decline

People with RA often develop cognitive issues, for instance with attention, memory, and executive function. Studies show that RA raises the risk of cognitive impairment and dementia, likely because of systemic inflammation.

Medication and Treatment

Because inflammation is so destructive, it’s critical to keep RA in remission or in the lowest disease state possible. By doing this, you can reduce the risk and severity of other diseases, along with the symptoms of RA. “But because people are older, there’s a sense by providers, rheumatologists included, that you can’t treat rheumatoid arthritis aggressively — and that’s dead wrong,” says Dr. Greer. According to one study, he says, “Patients with RA who were not treated died an average of 18 years earlier than those who were treated, from a heart attack or stroke.” Doctors may not treat it aggressively in older adults because they worry about risks and side effects from drugs, especially when people have other conditions, like kidney disease or osteoporosis. At the same time, there are potential risks of RA medications interacting with drugs you need for other conditions. But these issues can usually be managed with different drugs. “We have a large number of very effective treatments that have been developed over the past 25 years,” says Greer. Often your rheumatologist acts as your principal care provider, working with other specialists you may notice, such as cardiologists, endocrinologists, and nephrologists. They want to make sure your medications aren’t exacerbating symptoms of other diseases you have. For instance, corticosteroids contribute to osteoporosis, and nonsteroidal anti-inflammatory drugs (NSAIDS) can damage weakened kidneys. Every time you see any of your doctors, they should ask about any changes to your medications and look for potential issues. It may take some time to find the right combination of medications, and it’s not uncommon to have to change them periodically.

Practical Solutions for Daily Living

Self-care is an important part of managing rheumatoid arthritis, and that doesn’t change as you age, although exactly how you care for yourself may change over time. Here are some of the ways you can stay healthier, safer, and less fatigued.

Joint-Friendly Movement

It’s important to stay active, because exercise can reduce inflammation and strengthen muscles so they can better support your joints and keep them flexible. “I always insist my patients try to walk every day or secure into the pool, which can take the pressure off joints,” says Greer. Other gentle activities include tai chi and gentle yoga classes, which are great for balance, strength, and flexibility.

Energy Conservation

Fatigue is a common symptom of inflammation in people with RA, so it’s important to pace yourself and take rest breaks as needed.

Splinting

Splints can be used to immobilize joints while you sleep or during the day to help with pain. This can minimize movement and inflammation, says Greer. Discuss the use of a splint or brace with your rheumatologist to make sure you’re using it correctly.

Adaptive Technology

A variety of tools and devices can help if joint pain or decreased grip strength make everyday tasks difficult — from ergonomic kitchen tools, to tools to help with dressing and putting on makeup, to pill organizers, and more. You can also use voice-activated assistants such as Siri or Alexa to help with minor tasks like using your devices or turning on the radio.

Home Safety Modifications

You may need to make modifications in your home to both reduce the energy you use and to prevent falls or accidents. Think about moving things you often use to easily accessible locations — whether it’s your favorite clothes, a computer, or commonly used pots and pans in the kitchen. Try to decrease clutter, which can make it easier for you to move around without tripping over or bumping into stuff. Consider installing grab bars in the bathroom, and make sure your rugs are skid proof. You can work with an occupational therapist to help you adapt your home to your needs and limitations.

Who Can Help

If you’re having difficulty with any aspect of your rheumatoid arthritis management, there are people who can help.

• Your medical team: This will consist of your primary care provider and your rheumatologist, but you will likely see other specialists, depending on other conditions you may have. These may include an endocrinologist (for diabetes, thyroid disease, or osteoporosis), kidney or liver specialists, and heart specialists.
• Physical and occupational therapists: Physical therapists can help you with movement, strength, and flexibility. Occupational therapists can work with upper body dexterity and pain issues. Occupational therapists can recommend home assist devices and can also do splinting to immobilize joints if needed.
• Mental health: If you are struggling with mood disorders or pain, a mental health professional can help you manage depression and anxiety and provide strategies for coping with pain.
• Peer support: You may find it helpful to join online or in-person support groups for people with rheumatoid arthritis. It can be helpful to talk to people who understand what you’re dealing with and who can provide emotional support and practical advice. The Arthritis Foundation can connect you to support groups.

Rheumatoid arthritis can accelerate issues commonly associated with aging, such as muscle loss and increased risk of conditions like osteoporosis and cardiovascular disease. The need to aggressively treat RA to reduce inflammation and control symptoms remains important in older adults, and newer, safer drugs make that possible. Managing RA involves getting regular, joint-friendly exercise as well as using assistive devices for daily tasks, as needed, and considering home safety adaptations such as grab bars in the bathroom.