Prise en charge de l’arthrose du sujet très âgé

Osteoarthritis (OA) is one of the most disabling arthritic condition. Aging is a major risk factor and represent one of the three OA phenotypes currently identified, including mechanical or obesity-related osteoarthritis. In the very elderly, loss of function and pain due to osteoarthritis are primary concerns. Other conditions related to osteoarthritis are associated with aging, as malnutrition and sarcopenia. Management of osteoarthritis in the oldest old require a global evaluation and care. This evaluation emphasizes ethical concerns after a look at the cognitive impairment and functional disability, taking into account often-underestimated pain and stiffness. Assessment of muscular and nutritional parameters seem to be as important as the rheumatologic evaluation in this frail population. Symptomatic care is the best option in the impaired elderly whereas global care with a multidisciplinary approach is preferred in the frail population. Individualized decision making after global assessment is one of the specificities of the very elderly care because of the major risks of safety concerns, especially with pharmacological therapies.