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Anti-cyclic citrullinated peptide antibody (ACPA) positivity or the presence of bone erosions predicts a radiological joint destruction of EORA, but ACPA-negative EORA with a polymyalgia rheumatica (PMR) phenotype may also present. Biological disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors were beneficial both in older and in younger patients in terms of risk\u2013benefit balance. Implementation of a treat-to-target strategy could improve EORA outcomes, but older patients have more age-related comorbidities and interstitial lung disease than younger patients. Baseline comorbidities, more frequent methotrexate dose-dependent adverse events, serious infections, cardiovascular disease events, and malignancy all influence the choice of treatment and the treatment goals for older patients. Based on articles reviewed here, it is suggested that current treatment strategies for younger patients are also useful for ACPA-positive EORA and for ACPA-negative EORA with bone erosion. Differential diagnosis of ACPA-negative EORA without erosive arthritis and PMR with peripheral manifestations is challenging, and the treatment strategy of patients presenting with this overlap phenotype remained unclear. An appropriate treatment strategy for all patients with EORA still needs to be developed.<\/jats:p>","DOI":"10.1093\/mr\/roab087","type":"journal-article","created":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T10:15:05Z","timestamp":1637230505000},"page":"493-499","source":"Crossref","is-referenced-by-count":36,"title":["Treatment strategies for elderly-onset rheumatoid arthritis in the new era"],"prefix":"10.1093","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7181-7494","authenticated-orcid":false,"given":"Takahiko","family":"Sugihara","sequence":"first","affiliation":[{"name":"Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan"},{"name":"Department of Internal Medicine, Division of Rheumatology and Allergy, St. Marianna University School of Medicine, Kawasaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,11,10]]},"reference":[{"key":"2022042010110537300_R1","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1136\/annrheumdis-2019-216655","article-title":"EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update","volume":"79","author":"Smolen","year":"2020","journal-title":"Ann Rheum Dis"},{"key":"2022042010110537300_R2","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1136\/annrheumdis-2019-216656","article-title":"Efficacy of pharmacological treatment in rheumatoid arthritis: a systematic literature research informing the 2019 update of the EULAR recommendations for management of rheumatoid arthritis","volume":"79","author":"Kerschbaumer","year":"2020","journal-title":"Ann Rheum Dis"},{"key":"2022042010110537300_R3","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1111\/1756-185X.12998","article-title":"The age at onset of rheumatoid arthritis is increasing in Japan: a nationwide database study","volume":"20","author":"Kato","year":"2017","journal-title":"Int J Rheum Dis"},{"key":"2022042010110537300_R4","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1080\/14397595.2019.1682776","article-title":"Epidemiological characteristics of rheumatoid arthritis in Japan: prevalence estimates using a nationwide population-based questionnaire survey","volume":"30","author":"Kojima","year":"2020","journal-title":"Mod Rheumatol"},{"key":"2022042010110537300_R5","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keab209","article-title":"Characteristics of patients with difficult-to-treat rheumatoid arthritis in real-world","author":"Takanashi","year":"2021","journal-title":"Rheumatology (Oxford)"},{"key":"2022042010110537300_R6","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1002\/acr.21773","article-title":"2012 American College of Rheumatology guidelines for management of gout. 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