Nowadays, the importance of healthy and active aging is increasingly recognized due to the growing number of older individuals in the population. Autoimmune inflammatory rheumatic diseases can affect people at any stage of life, significantly impacting both morbidity, mortality and overall quality of life. Rheumatologic conditions that develop later in life have distinct characteristics compared to those that manifest at a younger age. Practitioners need to be familiar with these differences in order to make a timely diagnosis. Often, the first symptoms in elderly patients are nonspecific, constitutional symptoms, which are easily overlooked. Since multiple comorbidities accompany older age, treatment regimens should be individually adjusted, taking into account that these patients are more susceptible to severe infections compared to younger patients. However, the right and effective treatment should be provided to all patients, regardless of age, helping them to have active, dignified, and fulfilling seniority. In this review, common rheumatologic diseases are described with their uniqueness regarding older age and treatment options that appear to be well tolerated, efficacious, and without significant side effects in this age group.

The Giant cell arteritis (GCA) is the most common form of systemic vasculitis in elderly patients. The treatment includes high doses of steroids and interleukin (IL)-6 inhibitor tocilizumab, especially in refractory or relapsing disease or in cases where there is an increased risk of steroid-related adverse events. This report discusses the case of a patient with giant cell arteritis who underwent treatment with tocilizumab for four years. The treatment was successful and resulted in clinical remission. However, four years after starting the therapy, the patient developed spontaneous hematomas on their extremities. After further investigation, it was discovered that the patient had developed thrombocytopenia and hypofibrinogenemia, which required substitution therapy. Malignancy and immune-mediated causes of hypofibrinogenemia and thrombocytopenia were ruled out. The patient experienced an extended period of hypofibrinogenemia that lasted for two months after the last dose of tocilizumab. During this time, the levels of CRP remained very low. This could be because the continued inhibition of IL-6 caused impaired hepatic synthesis of acute phase response proteins, which led to low fibrinogen and CRP levels in serum. The purpose of this case-based review is to emphasize the necessity of regular fibrinogen check-ups in GCA patients treated with tocilizumab.

Breast cancer remains one of the major causes of mortality among women. Each year, approximately 2.26 million new breast cancer cases are diagnosed globally. Autoimmune inflammatory rheumatic diseases (AIRDs) are associated with higher overall cancer incidence. However, the relationship between AIRDs and breast cancer is not fully understood. Research findings are conflicting, with some studies reporting an increased risk and others suggesting a protective effect of AIRDs. A multidisciplinary approach, along with early recognition, is crucial for improving patient outcomes. The aim of this narrative review is to examine whether AIRD patients have a higher risk of developing breast cancer, particularly among elderly women.

The coexistence of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and infective endocarditis (IE) represents a diagnostic challenge because of substantial overlap in clinical, serological, and cardiac manifestations. We report the case of a patient with prolonged ear, nose, and throat manifestations, pulmonary nodules and cavitary lesions, markedly elevated PR3-ANCA, and small lesions adjacent to the aortic valve initially considered suspicious for infective vegetations. Despite repeatedly negative blood cultures, culture-negative IE remained an important diagnostic consideration, and antimicrobial therapy was continued. The patient subsequently developed rapidly progressive pulmonary disease and severe systemic inflammation despite broad-spectrum antimicrobial treatment. The combination of characteristic upper respiratory tract disease, pulmonary involvement, markedly elevated PR3-ANCA, and a marked clinical and radiological response to immunosuppressive therapy supported the diagnosis of granulomatosis with polyangiitis (GPA). Glucocorticoids and plasma exchange were initiated, followed by rituximab for remission induction. Conservative cardiac management with regular follow-up was chosen. This case highlights the diagnostic challenge of distinguishing PR3-ANCA-positive IE from AAV and the importance of integrating microbiological, imaging, and clinical findings to establish the diagnosis.