Index

A variability, 233 Abatacept, 67 classification criteria Absolute fracture risk model (FRAX), 242 clinical, 232 Acetaminophen, 62, 75 laboratary, 232 aCL ELISA tests, 233 clinical and subclinical atherosclerosis, 20 Acupuncture, 54 features, 231 Acute gouty arthritis therapy, 209 morbidity and mortality, 232–233 Acute pseudogout precipitators, elderly, 216 Anti-TNF agents Aerobic exercise, 109, 125, 126, 128, 261 adalimumab, 164 AION, 226 efficacy, 164 Alcoholic , 270 etanercept, 164 Amyloid myopathy, 269–270 infliximab, 165 Anakinra, 67 safety, 164 Analgesics, 52–53 Anti-TNF alpha agents, 66–67 ANCA-associated renal Anti-TNFa(alpha) therapy, 37 age indicator, 202 Apoptosis, 4 cyclophosphamide dose, 202 APS. See Antiphospholipid syndrome (APS) diagnosis, 32 Arthritis-specific federal policy initiatives morbidity and mortality determinant, 201 CDC Arthritis Program, 97 therapy, 32 Healthy People 2010, 96 Angiotensin converting enzyme (ACE), 262 The National Arthritis Action Plan, 96–97 Ankylosing Spondylitis (AS), 109–110 National Arthritis Act of 1974, 95–96 atherosclerosis, 20–21 National Arthritis Plan of 1976, 95–96 clinical features, 104 National Institute of Arthritis, 96 inspiratory muscle training, 110 Arthrocentesis pathology, 110 , 113–114 physical therapy interventions, 104 elbow sacroilitis, 110 joint effusion, 118 self-management, 110 olecranon bursa injection, 118 Anticonvulsants, 52 injection, 118 Antidepressants, 51–52 foot Antimalarials ankle injection (tibio-talar), 121 clinical pharmacology, 154 metatarsophalangeal joint injection, 122 efficacy, 154–155 Morton’s neuroma, 122 safety, 155 plantar injection, 121 Antineutrophil cytoplasmic antibodies, 198 posterior tibialis tendon sheath injection, 121–122 Antiphospholipid (aPL) antibodies hip, 120 diseases, 233–234 hyaluronates, 114 elderly, 234–236 indications, 113 Antiphospholipid syndrome (APS) knee injection, 120–121 aCL antibodies, prevalence local anesthetics, 114 aCL ELISA tests, 233 post injection care, 116 Louisville reference standards, 233 precautions and contraindications, 115 venous thromboembolism, 233 shoulder aPL antibodies, prevalence acromioclavicular joint (ACJ) injection, 117 autoimmune diseases, 233 biceps tendon injection, 117–118 elderly, 234–236 glenohumeral joint injection, 116 non-parametric tests, 233 subacromial-subdeltoid (SA-AD) bursal injection, 116–117 SLE patients, 233 suprascapular nerve block, 117 transient ischemic attacks and strokes, 233 side effects and complications, 114–115

Y. Nakasato and R.L. Yung (eds.), Geriatric : A Comprehensive Approach, 293 DOI 10.1007/978-1-4419-5792-4, © Springer Science+Business Media, LLC 2011 294 Index

Arthrocentesis (cont.) anatomy and physiology, 11 technical considerations, 115–116 fracture healing, 12–13 wrist and hand remodeling, 241 carpal tunnel injection, 118–119 resorption, 241 De Quervain’s injection, 120 senile osteoporosis, 11–12 first carpometacarpal (CMC) joint, 119 Bone mineral density (BMD), 179 ganglion, 119 Bone remodeling, 241 metcarpophalangeal and proximal interphalangeal Bone resorption, 241 joints injection, 119 Boost test, 39 injection, 119–120 Bracing or splinting, 77 Arthroplasty, 82 BRMs. See Biologic response modifiers (BRMs) Atherosclerosis ankylosing spondylitis, 20–21 antiphospholipid syndrome (APS), 20 C ASCVD, epidemiology of, 19–20 Calcium-containing crystal-associated . See Calcium atheroma, 17 pyrophosphate dihydrate (CPPD) deposition disease clinical implications, preventive strategies Calcium pyrophosphate dihydrate (CPPD) antimalarial agents, 22 deposition disease biological therapies, 22 and BCP pathogenesis, 218–219 corticosteroids, 21 clinical spectrum, 214–215 methotrexate, 22 diagnosis mycophenolate mofetil, 22 characteristic rhomboid shape demonstration, 216 NSAIDs and COX–2 inhibitors, 21 MSKUS, 216–217 , 21–22 epidemiology, 213 pathologic mechanisms, SLE and RA, 18–19 osteoarthritis and, 215 primary systemic vasculitis, 21 treatment psoriasis and psoriatic arthritis, 20 acute pseudogout attack management, 217 shared disease mechanisms, 17–18 biologic therapy, 218 systemic sclerosis, 21 colchicine or corticosteroids, 218 Atherosclerotic cardiovascular disease (ASCVD) dietary calcium, 218 endothelial dysfunction, 18 or methotrexate, 218 epidemiology magnesium, 218 RA and ASCVD mortality, 19 NSAIDs, 217 SLE and ASCVD mortality, 19 probenecid, 218 subclinical atherosclerosis in SLE and RA, 19–20 Cataracts, medium-and small-vessel vasculitis, 203–204 pathologic mechanisms, 18–19 Cevimeline, 290 Autoimmunity, 290 Chloroquine, 66 Azathioprine, 66 Churg-Strauss syndrome (CSS), 200 CNS angiitis diagnosis, 32–33 B therapy, 33 Barthels Index, 88 Cognitive-behavioral therapy (CBT), 53 Basic calcium phosphate (BCP) diseases Colchicine, 209, 270 and CPPD pathogenesis, 219–220 Comorbid psychiatric disorders, 53 Milwaukee shoulder syndrome, 219 Complementary and alternative medicine (CAM) practices, 77 B cells, 6 Corticosteroids, 21, 270 Biologic response modifiers (BRMs), 159–167 CPPD. See Calcium pyrophosphate dihydrate (CPPD) deposition abatacept, 166 disease anakinra, 166–167 Cryotherapy, 76 cancer, older RA patient, 163–164 Crystal arthropathies, 179 other safety concerns, 164 Crystal induced , 220 rituximab, 167 Cyclooxygenase–2 (COX–2) inhibitors, 21 TNF-a(alpha) action, 159 Cyclophosphamide, 282, 290 TNF inhibiting agents, older RA patient, 163 Cyclosporin, 66, 289–290 Biomechanic factors knee laxity, 180 LLI, 180–181 D proprioception, 181 Degenerative lumbar spinal stenosis (LSS) Bisphosphonate therapy classification, 102 males, 242 definition, 102 osteonecrosis of jaw, 244 pathophysiology, 103 BMD. See Bone mineral density (BMD) findings and interventions Bone Maine lumbar spine study, 105 age-related changes sensory and proprioceptive changes, 102 cytokines, 12 therapeutic exercise, 104–105 GH-IGF axis, 12 Dendritic cells (DC), 6 vitamin D, 14–15 Depot crystals, 221 Index 295

Dermatomyositis (DM) differential diagnosis autoantibodies, 265, 266 ESR and C-reactive protein (CRP), 146 diagnosis, 265 pro-inflammatory cytokine pattern, 146 incidence rates, 265 radiographic evaluation, 146 malignancy, 266–267 seropositive patients, 146 Deyo-Charlson Comorbidity Index, 211 serum rheumatoid factor (RF), 146 Disease-modifying anti-rheumatic drug (DMARD) inflammatory arthritis, 145 antimalarials symptoms, 145 clinical pharmacology, 154 treatment, 147–149 efficacy, 154–155 Electrical stimulation, 76 safety, 155 Enzyme-linked immunosorbent assay (ELISA), 233 anti-TNF agents Eosinophilic fasciitis (EF), 279 adalimumab, 164 Exercise, 110 efficacy, 164 aerobic, 109, 125, 126, 128 etanercept, 164 characterization, 125 infliximab, 165 definition, 125 safety, 164 degenerative LSS, 104 biologic response modifiers and fall prevention, 243–244 abatacept, 166 interventions, 98, 107 anakinra, 166–167 muscle strengthening, 126, 128 cancer, older RA patient, 163–164 nursing home patient, 77 other safety concerns, 164 range-of-motion, 102 rituximab, 167 sarcopenia, 261 TNF-a(alpha) action, 159 stabilization and closed chain, 102 TNF inhibiting agents, older RA patient, 163 Eye dryness. See Xeropthalmia introduction, 151–152 Ezetimibe, 270 leflunomide clinical pharmacology, 155 efficacy, 156 F safety, 156 Facioscapulohumeral dystrophy, 267 methotrexate Febuxostat, 210 clinical pharmacology, 156–157 Fibrates, 270 efficacy, 157 Fibric acid derivatives, 270 safety, 157–158 Fibromyalgia syndrome (FMS) physiologic changes with aging chronic pain assessment, 46–47 pharmacodynamics, 153–154 classification criteria, 45 pharmacokinetics, 152–153 clinical presentation, 47 sulfasalazine definition and epidemiology, 45–46 clinical pharmacology, 158 differential diagnosis, 48, 49 efficacy, 158 pain processing and analgesia, 46 safety, 158–159 pathogenesis, 46 Disease modifying anti-rheumatic drugs (DMARDs), 147 physical examination, 47–48 azathioprine, 66 prevalence, 45 chloroquine, 66 , 47 cyclosporine, 66 treatment hydroxychloroquine, 66 analgesics, 52–53 leflunomide, 65–66 anticonvulsants, 52 methotrexate, 65 antidepressants, 51–52 sulfasalazine, 66 comorbid psychiatric disorders, 53 Drug-induced myopathy non-pharmacological management, 53–54 alcoholic myopathy, 270 Fluoxetine, 52 colchicine, 270 Fracture healing, 12–13 corticosteroids, 270 Fragility fracture, osteoporosis, 241 lipid lowering agents, 270 Frailty and Injuries: Cooperative Studies of Intervention Techniques drugs, 270–271 (FICSIT) studies, 126 Duloxetine, 52

G E Gadolinium, 279 Elderly onset rheumatoid arthritis GCA. See Giant cell (GCA) aging factors, 147 Geriatric Depression Scale, 88 characterization, 145 Geriatric gout management clinical features accurate diagnosis, 209 de novo development, 145 acute gouty arthritis therapy, 209 disease duration, 146 in elderly patients physical examination, 146 drug adherence rates, 210 vs.YORA, 146 health care costs, 211 296 Index

Geriatric gout management (cont.) T-cell migration, 5 hyperuricemia treatment Th1 and Th2 responses, 5 allopurinol, 210 Th17 cells, 5 febuxostat, 210 vaccine efficacy, elder patients, 7 serum urate level, 209–210 Immunosenescence, 7 Geriatric rheumatology adaptive immunity definition, 86 B-cells, 253–254 future aspects, 89–90 Gavazzi and Krause postulate, 254 Gerontorheumatology outpatient service (GOS) memory T-cells, 253 aims and objectives, 87 T-lymphocytes, 253 assessment, ICF model, 88–89 hematopoietic stem cell (HSC), 251 follow-up actions, 89 innate immune system future aspects, 89–90 alpha-and beta-defensins, 252 Nijmegen-based GOS, 90 dendritic cells (DC), 252 organization and procedure, 87–88 Drosophila, 252 patient evaluation, 89 lipopolysacharide (LPS), 252 Giant cell arteritis (GCA) macrophage functions, 252 diagnosis, 31 natural killer (NK) cells, 252 epidemiology, 225 phagocytosis, 252–253 features, 226 toll-like receptors (TLRs), 252 histology, 227 Inclusion body (IBM) imaging, 226–227 diagnostic criteria, 264, 265 large-vessel, 227–228 hereditary inclusion body (h-IBM), 264 therapy, 31 sporadic (s-IBM), 264–265 treatment, 228 Infectious arthritis Glucocorticoids, medium-and small-vessel vasculitis, 203–204 aging, 254 predisposing risk factors, 254 therapeutic management, 254 H Inflamm-aging, 7 Hand osteoarthritis, 175–176 Inpatient rehabilitation facilities (IRFs), 80–81 Health policy, 94–95 Interferon-gamma release assays (IGRAs), 39 Hematopoietic stem cell (HSC), 6–7 Henoch-Schönlein purpura, 202 Hip fracture, 82 J Hip osteoarthritis, 174–175 Joints aspiration and injections. See Arthrocentesis HMG-CoA reductase (statins), 262 Hyaluronic acid viscosupplementation, 67–68 Hydroxychloroquine (HCQ), 22, 66, 140, 154, 155, 218, 290 K Hyperthyroidism, 269 Kellgren–Lawrence (KL) radiographic grading score, 173 Hyperuricemia treatment Knee osteoarthritis, 175–177 allopurinol, 210 febuxostat, 210 serum urate level, 209–210 L Hypothyroidism, 269 Langerhans cells (LCs), 6 Large-vessel giant cell arteritis, 227–228 Late-onset I clinical evaluation, 136–140 IA depocorticosteroids, 194 differential diagnosis, 138 Immune response therapies disease manifestations, 137–138 abatacept, 67 disease prognosis, 140–142 Anakinra, 67 epidemiology, 135–136 anti-TNF alpha agents, 66–67 frequency, 136 rituximab, 67 laboratory work-up, 136–140 Immune system serologic findings, 139–140 B cells, 6 syndrome characterization, 138, 139 components, 3 treatment, 140 dendritic cells, 6 Late onset mitochondrial myopathy, 267–268 hematopoietic stem cell, 6–7 Late onset muscular dystrophies inflamm-aging, 7 facioscapulohumeral dystrophy, 267 thymic involution, 6–7 limb girdle dystrophy, 267 T lymphocytes oculopharyngeal dystrophy, 267 apoptosis, 4 Late onset , 275, 280 immune replicative senescence, 6 Leflunomide, 65–66 impaired IL–2 production and proliferation, 5 clinical pharmacology, 155 memory and naïve human T cells, 4–5 efficacy, 156 regulatory T lymphocytes, 5 safety, 156 Index 297

Leukocytoclastic vasculitis (LCV), 202 Myopathies Limb girdle dystrophy, 267 amyloid myopathy, 269–270 Limb length inequality (LLI), 180–181 (DM), 265–267 Lipid lowering agents, 270 drug-induced myopathy Local extrinsic risk factors alcoholic myopathy, 270 occupational demands, 180 colchicine, 270 trauma and physical activity, 179–180 corticosteroids, 270 Local intrinsic risk factors lipid lowering agents, 270 lower extremity joint alignment, 180 statin drugs, 270–271 muscle strength, 180 endocrine/metabolic disease Long-term acute care hospitals (LTACs), 79–80 osteomalacia, 269 Louisville reference standards, 233 thyroid disease, 268–269 idiopathic inflammatory myopathies (IIM) hereditary inclusion body myopathies (h-IBM), 264 M sporadic inclusion body myositis (s-IBM), 264–265 Medium-and small-vessel vasculitis late onset mitochondrial myopathy, 267–268 ANCA-associated renal vasculitis, 201–202 late onset muscular dystrophies, 267 antineutrophil cytoplasmic antibodies, 198 medium-and small-vessel vasculitis, 203–204 Churg-Strauss syndrome, 200 paraspinal myopathies, 268 epidemiology, 197 (PM), 265–267 leukocytoclastic vasculitis (LCV), 202 Myositis. See specific types management in elderly population baseline organ function, 203 cataracts, 204 N comorbid considerations, 203 Nephrogenic systemic fibrosis, 279 glucocorticoids, 203–204 Nicotinic acid, 270 glucose intolerance and diabetes mellitus, 204 Non-modifiable systemic risk factors infection, 203 age, 177 myopathy, 204 congenital/developmental conditions, 179 osteoporosis, 204 gender and hormones, 177 polypharmacy, 204–205 genetic factors, 177 microscopic polyangiitis, 200–201 geographic/racial/ethnicity, 177 polyarteritis nodosa, 201 Nonsteroidal anti-inflammatory drugs (NSAIDs), 7–8, 21, 63, 64, 68, Wegener’s granulomatosis 75–76, 217 characterization, 198 Nursing home patient diagnosis, 199 arthritis, 73 elderly, 199 functional assessment Metabolic bone diseases. See Osteomalacia; Osteoporosis components, 74 Methotrexate, 22, 65, 140 interdisciplinary care planning meeting, 74 clinical pharmacology, 156–157 limitations, 74 efficacy, 157 mandated minimal data set, 74 safety, 157–158 validated tools, 74 Microscopic polyangiitis, 200–201 pain assessment Milnacipran, 52 cognitive impairment, 75 Milwaukee shoulder syndrome, 219 monoarticular joint inflammation, 74 Mini mental state examination (MMSE), 88 non pharmacological management, 76–77 Modifiable risk factors osteoarthritis, 74 BMD, 179 pharmacological management, 75–76 crystal arthropathies, 179 tools, 75 nutrition, 179 treatment goals, 75 obesity, 179 Nursing homes, 81–82 Monoclonal gammopathy of undetermined significance (MGUS), 279 Motor unit action potentials (MUAP) assessment, 263 O Mouth dryness. See Xerostomia Oculopharyngeal dystrophy, 267 Muscle aging, 259 Opioid analgesics, 63–65 Muscle disease symptoms, clinical evaluations Opioid therapy, 76 extracellular glutathione depletion, 263 Osteoarthritis (OA) motor unit action potentials (MUAP) aerobic exercise, 109 assessment, 263 aging and, 181–182 muscle tenderness, 262 calcium pyrophosphate dihydrate (CPPD), 213 myopathic weakness, 262 clinical features, 103–104, 109 Muscle strengthening exercise, 126, 128 diagnosis, 191–192 Musculoskeletal ultrasound (MSKUS), 216–217 epidemiology Mycophenolate mofetil (MMF), 22 classification, 187 Myofascial pain, 48 clinical, 173–174 298 Index

Osteoarthritis (OA) (cont.) males, 242 criteria for classification, 173 medical costs, 105–106 demographic characteristics, 187 medium-and small-vessel vasculitis, 204 radiographic, 173 morbidity and mortality, elderly, 12 symptomatic, 173 nutrition, 243 functionally based exercises, 109 pathophysiology, 13–14 hand, 175–176 physical examination findings and interventions hip, 174–175 bone mineral density, 106 imaging goals, 106 bone scan, radio-labeled bisphosphonates, 191 high and low impact aerobic exercise, 106 computed tomography (CT), 191 postmenopausal women, 106, 107 MRI, 191 postural re-education, 106 , 191 senile osteoporosis, 11–12 ultrasonography, 191 therapeutic options knee, 175–177 bisphosphonates, 244 patella malalignment and abnormal tracking, 109 calcitonin, 245 pathophysiology, 104 raloxifene, 244 cartilage structure, 188 teriperatide, 245 chondrocytes, 188 Oxalate crystal deposition disease, 221 juxta-articular bone, 189 synovium, 189 prognosis, 195 P proprioceptive changes, 109 Paget’s disease of bone range-of-motion (ROM) exercises and joint mobilization, 109 characterization, 246 risk factors, 109 prevalence, 246 biomechanic, 180–181 treatment, 247 local extrinsic, 179–180 Palmar fasciitis, 279 local intrinsic, 180 Paraproteinemia, 279 modifiable, 179 Paraspinal myopathies, 268 non-modifiable systemic, 177–179 Pharmacotherapy considerations symptoms and signs antirheumatic medication selection joint enlargement characteristics, 189 acetaminophen, 62 nociceptor pain, 189 corticosteroids, 65 stiffness, 189 DMARD therapies, 65–66 therapy hyaluronic acid viscosupplementation, 67–68 acetaminophen, 193 NSAIDs, 63, 64 capsaicin, 194 nutritional supplements, 67 education and physical measures, 192 opioid analgesics, 63–65 flavocoxid, 194 economic and health-care system, 68–69 glucosamine, 194 pharmacodynamics, 61–62 hyaluronic acid, 194 pharmacokinetic changes IA depocorticosteroids, 194 drug absorption, 60 muscle relaxants, 194 drug distribution, 61 non-pharmacologic program, 193 elimination, 61 NSAIDs, 193–194 metabolism, 61 pharmacologic, 193 risks and special concerns, 69 tramadol, 194 topical analgesics, 68 weight control, 193 Physical activity, older adults with arthritis Osteomalacia, 15, 269 aerobic exercise, 125 asymptomatic, 246 challenges and opportunities, 129 characteristic features, 242 characterization, 125 25 dihydroxy-vitamin D level, 246 definition, 125 treatment, 246 detriments of inactivity vitamin D deficiency, 245–246 frailty, 127 Osteoporosis immobility, 127 definition, 241 immobilizing leg muscles, 127 diagnosis epidemiology, 126–127 absolute fracture risk model (FRAX), 242 health benefits BMD measurements, 242 FICSIT studies, 126 fracture risk factor assessment, 242 muscle strengthening, 126 exercise, 243–244 muscle contraction, 125 fall prevention strategy, 244 pattern, 125 fragility fracture, 241 physician advice/support, 129 impact physiologic benefits, 127–128 hip fractures, 241 range of motion, 125 vertebral fractures, 241 recommendations, 128–129 Index 299

social physique anxiety, 129 pharmacologic agents, 278 weight bearing, 125 Regulatory T cells (Tregs), 3, 5 Pilocarpine, 290 Rheumatoid arthritis (RA), 33 PMR. See (PMR) aging, 7 POEMS syndrome, 279 aquatic exercise, 108 Polyarteritis nodosa (PAN), 201 clinical features and physical therapy intervention, 103, 108 diagnosis, 31 epidemiology, 35–36 therapy, 31 history, 39 Polymyalgia rheumatica (PMR) latent tuberculosis infection case features, 225 biologic therapy, elderly RA patients, 41 classification criteria, 225 detection, 39–40 diagnosis, 101 diagnosis, 39 differential diagnosis, 226 screening, guidelines, 41 epidemiology, 225 TST vs. QFT-IT, 40–41 histology, 227 neuropsychiatric manifestations, 28 imaging, 226–227 non-or low-impact aerobic exercises, 108 physical therapy interventions patient education, 108 bone and muscle strength maintenance, 102 physical examination findings, 106 pathophysiology, 103 range-of-motion exercises and isometric exercises, 108 physical examination findings, 101–102 resistive exercises, 108 recommendations, 103 resting and dynamic splints, 108 signs and symptoms, 102 Rituximab, 67, 290 treatment, 228 Polymyositis (PM) autoantibodies, 265, 266 S diagnosis, 265 Sarcopenia incidence rates, 265 behavioral alteration, 260 malignancy, 266–267 bone and muscle strength, descriptors for, 261 Post acute care definition, 259 home health care, 82 disuse deconditioning, 260 inpatient rehabilitation facilities impaired strength, 259 musculoskeletal conditions, 80–81 muscle aging, 259 patient characteristics, 80 muscular alterations, 260 prospective payment system, 80 neuromuscular factors, 260 long-term acute care hospitals, 79–80 treatment rehabilitation, 82–83 exercise, 261 skilled nursing facilities, 81–82 protein intake, 262 Primary antiphospholipid syndrome (PAPS), 231 strength training, 261 Progressive interstitial lung disease (ILD), 282 therapies, 262 Propoxyphene, 76 Scleroderma Proprioception, 181 age at disease onset, impact of Prospective payment system (PPS), 80 mortality, 280 Pseudogout pulmonary arterial hypertension (PAH), 280 acute, 216 aging scleroderma patient characterization, 214 heart diseases, 281 chronic, 214 PAH, 281 CPPD, 213 skin telangectasias, 281 familial forms, 214 skin thickening, 280 Psoriasis and Psoriatic arthritis, 20 classification and demographics, 276 Public health, 93–94 clinical features Pulmonary arterial hypertension (PAH), 280–282 Raynaud’s phenomenon, 276–278 systemic disease, 278 eosinophilic fasciitis (EF), 279 Q gadolinium, 279 Quantiferon-TB Gold In Tube (QFT-IT) test, 39 management geriatric treatment principles, 283 organ specific therapies, 282 R PAH, 282 Raloxifene, 244 progressive interstitial lung disease (ILD), 282 Raynaud’s phenomenon skin, 282–283 abnormal nailfold capillary microscopy, 277 treatment principles, 281–282 age of onset, 276 monoclonal gammopathy of undetermined significance (MGUS), disease (CTD), 276–277 279 diagnosis, 277–278 nephrogenic systemic fibrosis, 279 differential diagnosis, 276, 277 palmar fasciitis, 279 distinguishing feature, 276 paraproteinemia, 279 300 Index

Scleroderma (cont.) Systemic sclerosis, 21, 278 POEMS syndrome, 279 Systemic vasculitis, 30 scleromyxedema, 279 Scleromyxedema, 279 Secondary antiphospholipid syndrome (SAPS), 231 T Selective estrogen receptor modulator (SERM), 244 Temporal arteritis. See Giant cell arteritis (GCA) Selective serotonin reuptake inhibitors (SSRIs), 52 Teriperatide, 245 Senile osteoporosis, 11–12 Thermal therapy, 76 Septic arthritis, 10 Thymic involution, 6–7 Short questionnaire to assess health-enhancing physical activity Thyroid disease (SQUASH), 89 hyperthyroidism, 269 Sjögren’s syndrome (SS) hypothyroidism, 268–269 chronic inflammatory process, 29 T lymphocytes clinical features apoptosis, 4 cancer, 289 immune replicative senescence, 6 esophagus dryness, 288 impaired IL–2 production and proliferation, 5 exocriine glands destruction, 288 memory and naïve human T cells, 4–5 extraepithelial diseases, 288–289 regulatory T lymphocytes, 5 immunological changes, 289 T-cell migration, 5 lymphoma complications, 289 Th1 and Th2 responses, 5 periepithelial diseases, 288 Th17 cells, 5 sicca symptoms, 288 Tricyclic antidepressants (TCAs), 51–52 thyroid disease, 289 Tuberculosis, RA vaginal dryness, 288 biologic therapy, elderly patients clinical manifestation, 29 recommendations, 41 definition, 287 risk during, 37–38 diagnosis, 30 risk prior to, 37 epidemiology, 287–288 clinical and radiological characteristics, 38 neurologic involvement, 29 epidemiology, 35–36 pathophysiologic mechanism, 30 history, 35 prevalence, 29 primary Sjögren’s syndrome, 287, 288 secondary Sjögren’s syndrome, 287, 289, 290 U therapy, 30 Ultrasound guided arthrocentesis treatment, in geriatric patient advantages, 122 systemic manifestations, 290 indirect technique, 122 xeropthalmia, 289–290 real time technique, 123 xerostomia, 290 Skilled nursing facility (SNF), 81–82 Social physique anxiety, 129 V Sporadic inclusion body myositis (s-IBM) Varicella-zoster virus (VZV), 5 diagnosis, 264 Venlafaxine, 52 standard medical therapy, 264 Visual analogue scales (VAS), 88 Statin-induced myopathy, 270 Statins, 21–22 Sulfasalazine, 66 W clinical pharmacology, 158 Wegener’s granulomatosis efficacy, 158 characterization, 198 safety, 158–159 diagnosis, 199 Systemic lupus erythematosus (SLE), 231 in elderly autoantibodies, 28 vs. general patients, clinical characteristics, 199 brain MRI, abnormalities, 28 survival curves, patients, 200 classification, 136 Widespread pain diagnosis, 28, 136 fibromyalgia syndrome (see Fibromyalgia syndrome (FMS)) disease activity, 141 pathogenesis, 46 late-onset lupus (see Late-onset lupus) psychiatric conditions, 48 organ function decline, 28 pharmacological interventions, 140 prevalence, 28 X survival, 142 Xanthine oxidase (XO) inhibitor, 210 therapy, 29 Xeropthalmia, 289–290 treatment, 140 Xerostomia, 290