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News
Inflammatory arthritis is frequently missed in older adults — and primary care providers are key to changing that. Rheumatologist Dr. Una Makris shares red flags, diagnostic best practices, and when to start treatment without waiting for a specialist. The bottom line: joint pain, fatigue, and stiffness should never be written off as just getting old.
Nearly one-third of U.S. adults aged 65 and older have arthritis, and while osteoarthritis gets most of the attention, inflammatory arthritis — including rheumatoid arthritis, gout, and spondyloarthritis — is frequently overlooked. According to rheumatologist Dr. Una Makris, diagnosis is often delayed by more than a year in older adults, leading to irreversible joint damage, functional decline, and prolonged steroid exposure. Since primary care providers are usually the first point of contact, early recognition is critical.
Dr. Makris outlines a practical approach: start with a thorough history and physical exam, look for morning stiffness lasting over an hour, joint warmth and swelling, and symptoms that improve with activity. Labs like ESR, CRP, RF, and anti-CCP can support — but not replace — clinical judgment. If inflammatory arthritis is strongly suspected and rheumatology access is delayed, starting a DMARD (like methotrexate) is appropriate and guideline-concordant. Glucocorticoids should be used sparingly and only as a short-term bridge.
Key Takeaways:
Why it matters: Delayed diagnosis means prolonged suffering and preventable disability. PCPs who recognize inflammatory patterns early can dramatically improve outcomes for older patients.
