Late-Onset Rheumatoid Arthritis (LORA): A Diagnostic and Therapeutic Challenge Among Older Patients Visiting a Poorly Resourced Health-Care Setting

Abstract

Late-onset rheumatoid arthritis (LORA) presents a unique diagnostic challenge among older patients, particularly in poorly resourced healthcare settings. As global life expectancy increases, so does the prevalence of LORA, a condition that differs significantly from young-onset rheumatoid arthritis (YORA). This review explores the distinct clinical presentation, differential diagnosis, laboratory findings, and treatment challenges of LORA, emphasising its impact on low- and middle-income countries. The atypical and often acute onset of LORA, coupled with limited access to healthcare and diagnostic tools, contributes to significant diagnostic delays. These delays are compounded by a scarcity of healthcare providers, particularly rheumatologists, and the lack of essential laboratory tests in remote areas. Moreover, older adults often face additional barriers, including poor social support, reluctance to use allopathic medicines, and non-compliance with follow-ups. Effective management of LORA requires not only an understanding of its unique characteristics but also a tailored approach that considers the constraints of resource-limited settings. This review highlights the urgent need for specific guidelines and strategies to improve the diagnosis and management of LORA, thereby addressing the growing healthcare needs of older population in LMICs.

Keywords: diagnostic and therapeutic challenge; late-onset rheumatoid arthritis (LORA); older patients.