Connective Tissue Disorders and Vasculitis in the Elderly

Connective tissue disorders form a wide spectrum of disorders including systemic lupus erythematosus, (SLE), systemic sclerosis (SSc), Sjogren’s syndrome (Ss-S), mixed connective diseases, giant cell arteritis, polymyalgia rheumatica and polyarteritis nodosa. All are immune-complex-mediated autoimmune conditions. The connective tissue disorders occur at all ages but higher in prevalence in the young adults. Immune function wanes with age. Immunosenescence affects both innate and adaptive immunity. The susceptibility of the elderly to autoimmune diseases, infectious diseases and cancer is directly or indirectly related to age-related changes of the immune system. Vasculitis constitutes a heterogenous group of diseases characterised by inflammation and necrosis of the blood vessels and may affect the large, medium, small arteries, arterioles, veins and venules. Several mechanisms are involved in the vascular inflammation, namely, immune-complex disease, antibody- mediating disease, antibody-dependent cellular toxicity, and endothelial activation among others. The involvement of different end organs, the kidney, lung, central nervous system and gastrointestinal tract, and the spectrum of clinical presentation and the varying types of inflammatory cells involved make classification baffling. However, an important progress is the appreciation of vessel size, the distinction between primary and secondary vasculitis and pathogenic markers.