Joint problems in older people are common–both as ongoing chronic problems but also individuals presenting for the first time with joint symptoms. The assessment of an elderly person presenting with joint symptoms poses special challenges. There is a large potential differential diagnosis and more than one form of arthritis may co-exist, most commonly osteoarthritis. The clinical presentation in older patients may differ from typical findings in a younger individual and co-morbid conditions may complicate management strategies. In this article we discuss the differential diagnosis and management of conditions presenting as inflammatory arthritis in older people.