Abstract
Immunosenescence, the aging of immune system, is known to be a risk factor for infection and cancer. Advanced age has been associated with a wide range of disorders linked to both innate and adaptive immune systems. Further, the associated comorbidities like diabetes, renal failure, malignancy etc., lead to an immunosuppressed state, which needs greater precautions. Age also modifies drug-related pharmacokinetic parameters like absorption, distribution, metabolism, and excretion. All these factors warrant cautious use of immunomodulators in elderly rheumatoid arthritis (RA) patients. Moreover, majority of the clinical trials exclude the elderly population and limit their studies only to younger subjects. This selection bias, along with limited studies on geriatric population, makes the management of this special group of patients very challenging. Even though, the present evidence from clinical trials suggests that DMARDs and biologic agents have good efficacy and safety profile in elderly patients with RA, such individuals are often undertreated. The present data is not sufficient for the development of evidence-based guidelines for this population. Thus, additional clinical studies focusing on pharmacokinetics, efficacy, and safety of immunomodulators in elderly patients are warranted.
Highlights
The proportion of elderly rheumatoid arthritis (RA) patients worldwide is on the rise and approximately 30% of RA cases occur in this age category
This review focuses on the latest data pertaining to the use of traditional DMARDS and the newer biologic therapies in the geriatric rheumatoid patients
The United States veterans with elderly onset RA (EORA) and the North American CORRONA (Consortium of Rheumatology Researchers of North America), it has been shown that the overall usage of DMARDs has increased over the last decade.[1, 2]
Summary
The proportion of elderly rheumatoid arthritis (RA) patients worldwide is on the rise and approximately 30% of RA cases occur in this age category. The quality of life in elderly patients can be greatly improved by the judicious use of immunomodulatory drugs and through increased awareness, monitoring, and prevention of medication side effects. The use of glucocorticoids was more in this population, with less usage of combination DMARDs and biologic therapy, despite comparable disease severity and activity. These inequalities have been noted in the Dutch and Swedish registries as well, even though elderly patients often have more active disease.[3] These findings were further confirmed in the Swiss registry, which showed that glucocorticoids were used as first-line treatment in 68% of elderly vs 25.4% of younger patients, and the biological DMARDs were less commonly used during follow-up.[4]. The elderly with RA should not be denied from receiving optimal treatment with these medications
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