Abstract
BackgroundThe incidence of rheumatoid arthritis (RA) is expected to increase over the next 10 years in the European Union because of the increasing proportion of elderly people. As both RA and ageing are associated with emerging comorbidities such as cardiovascular disease, malignancies and osteoporosis, these factors will have a profound effect on the management of RA. In addition, both increasing age and comorbidities may independently alter commonly used RA-specific outcome measures.DiscussionAge-related decline in immune cell functions (immunosenescence), such as a decrease in T-cell function, may contribute to the development of RA, as well as comorbidity. The chronic immune stimulation that occurs in RA may also lead to premature ageing and comorbidity. The interplay between RA, ageing and (emerging) comorbidities is interesting but complex. Cardiovascular disease, lung disease, malignancies, bone and muscle wasting and neuropsychiatric disease all occur more frequently in RA patients as compared to the general population. It is unclear how RA should be managed in ‘today’s world of multiple comorbidities’. Evidence that treatment of RA improves comorbidities is currently lacking, although some promising indirect observations are available. On the other hand, there is limited evidence that medication regularly prescribed for comorbidities, such as statins, might improve RA disease activity. Both ageing and comorbidity have an independent effect on commonly used outcome measures in the RA field, such as the Health Assessment Questionnaire (HAQ) and the clinical disease activity index (CDAI). Prospective studies, that also account for the presence of comorbidity in (elderly) RA patients are therefore urgently needed. To address gaps in knowledge, future research should focus on the complex interdependencies between RA, ageing and comorbidity. In addition, these findings should be integrated into daily clinical practice by developing and testing integrated and coordinated health care services. Adaptation of management recommendations is likely required.SummaryThe elderly RA patient who also deals with (emerging) comorbidities presents a unique challenge to treating clinicians. A paradigm shift from disease-centered to goal-oriented approach is needed to develop adequate health care services for these patients.
Highlights
The incidence of rheumatoid arthritis (RA) is expected to increase over the 10 years in the European Union because of the increasing proportion of elderly people
The research to date has successfully identified the epidemiology of comorbidity in patients with RA, a variety of determinants that influence outcome and to some extent the consequences associated with the presence of comorbidity
It seems clear that elderly RA patients who face comorbidity will need a different management approach since the needs of these patients are more than just the sum of needs in relation to single diseases [106]
Summary
Rheumatoid arthritis, ageing and immunosenescence To understand how ageing may affect RA and vice versa, one should first understand the contribution of the underlying cellular mechanisms. Effect of ageing and comorbidities on RA-specific outcome measures The functional status of a patient with RA and response to treatment is measured by several disease-specific outcome measures, such as the Disease Activity Score −28 (DAS28), Health Assessment Questionnaire (HAQ) and the American College of Rheumatology (ACR) remission criteria [55,56,57] These outcome measures are often used in randomised controlled trials (RCTs). Ranganath et al evaluated 1584 RA patients in a prospective cohort study and found that increasing numbers of comorbidities were independently correlated with less improvement in the clinical disease activity index (CDAI) after initiation of anti-rheumatic treatment [58]. A small-sized randomised study of 21 months duration by Engvall et al including 40 patients, the use of TNFinhibitors was associated with an increase in body fat mass (+3.8 (1.6-5.9) kg in the TNF inhibitor group vs +0.4 (−1.5-2.2) kg (p = 0.04) in the conventional synthetic. The evidence to routinely prescribe antidepressants as analgesics in patients with RA is inconclusive [105]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
