Connective Tissue Diseases and Vasculitis (Behçet’s Disease and Other Vasculitis in the Elderly)

Connective tissue diseases and vasculitis in the elderly present unique diagnostic and therapeutic challenges due to age-related immune changes, comorbidities, and polypharmacy. Dermatomyositis shows a bimodal age distribution, with an increased risk of associated malignancies in elderly patients, particularly lung, ovarian, breast, and gastrointestinal cancers. Typical clinical features include cutaneous manifestations and progressive muscle weakness, often with a chronic course in older adults. Systemic lupus erythematosus (SLE) in the elderly, termed late-onset SLE, presents with more benign disease activity but often delayed diagnosis due to nonspecific symptoms such as fatigue and weight loss. Elderly SLE patients more frequently develop serositis, Sjogren-like symptoms, and have less classical malar rash and renal involvement, necessitating careful differentiation from malignancies and endocrine disorders. Sjogren’s syndrome also occurs in older adults, with a milder clinical course but frequent sicca symptoms often misattributed to aging or medications. Vasculitis in this population includes primary forms like giant cell arteritis and ANCA-associated vasculitis, as well as secondary vasculitis linked to connective tissue diseases, malignancies, infections, and drugs. Treatment strategies require balancing immunosuppression efficacy and side effect risks, particularly glucocorticoid toxicity and infection susceptibility. Awareness of these complex overlapping syndromes is essential for optimizing care in elderly patients.