The connective tissue diseases and vasculitides are primarily conditions of the early and middle years. However, a significant proportion of patients do present in later life, and some conditions, such as giant cell arteritis, are almost exclusively confined to older patients. In later years, their presentation may differ from the classical descriptions and require a broader diagnostic sieve. Thirty per cent of elderly patients with pyrexia of unknown origin have a multi-system disorder. Autoantibody tests throw up more false positives with the risk of over-diagnosis and treatment is further complicated by the burden of co-existent disease and morbidity from therapeutic side-effects.