Treatment of the elderly rheumatoid arthritis patient

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Abstract

Rheumatoid arthritis (RA) is a destructive inflammatory arthritis of unknown origin. With the advent of DMARDs and biological agents, the goal of treatment is the induction of remission and prevention of tissue damage in both the elderly and the general RA population. Aging, in particular, can be associated with a decline in the physiologic function of body organs, as well as considerable changes in pharmacodynamics and pharmacokinetics. This makes treatment challenging in elderly RA patients. Thus, a treatment plan must be tailored to meet the severity of the disease and to account for the presence of any comorbidities, especially in the elderly, who may be more frail. Adverse events, such as an increased incidence of infections and malignancy, in some elderly RA patients might be attributed to increased comorbidities with physiologic aging rather than the patient's chronological age. In particular, this applies to the natural decrement in immunoregulation that occurs in the elderly. In summary, the treatment of RA in the elderly is not different from the treatment of RA in the young once one considers the comorbidities associated with the normal decrements and changes in pharmacokinetics (e.g., change in renal and hepatic function) and pharmacodynamics (e.g., immunosenescence) that are associated with aging.

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