Other systemic diseases in the elderly

The prevalence of systemic diseases depends on patient age. One third to one half of the patients with Wegener's granulomatosis are over 60 years at the diagnosis. In the elderly, renal insufficiency, lymphopenia and central nervous system involvement are more frequent, and upper airways involvement and hemoptysis less frequent. Signs suggestive of temporal arteritis may initiate the disease. Mortality is increased in the elderly, and aging is an independent predictor of poor prognosis. Henoch-Schonlein purpura is uncommon in adulthood; one quarter of adult cases involves an elderly patient. End-stage renal failure and association with neoplasia are common. In some cases, synchronous course of purpura and neoplasia leads to consider it as a true paraneoplastic syndrome. Periarteritis nodosa in the elderly is characterized by an increased frequency of the association with viral B hepatitis and skin vasculitis. Histological location of necrotizing arteritis involving the temporal artery is possible. It should be considered as a borderline disease, and treated as the more severe disease. Aging is predictive of poor prognosis. Cholesterol emboli are a classic complication of atheroembolic disease and may mimic an inflammatory and multisystemic disease with renal, cardiac, pulmonary, digestive, neuropsychiatric, skin and muscle involvements due to ischemic phenomena leading to necrosis. One-year mortality is over 60% in the symptomatic forms.