Treating Rheumatoid Arthritis Through the Life Course

Abstract

Rheumatoid arthritis (RA) is a systemic autoimmune disease that can occur at any age, with very young onset at age 14 to elderly onset at age 60 or more. However, the incidence of RA increases with age. The elderly RA population consist of elderly onset RA patients and young onset RA patients who aged naturally. This elderly RA population is expanding and constitute one third of the general RA population. It seems that elderly onset RA has a characteristic clinical presentation and biological profile along with worse long-term outcomes than young onset RA. Despite this, the management of elderly RA remains unsatisfactory with clinicians preferring less aggressive treatment, perhaps due to a lack of clear guidance and concerns about side effects of RA therapy in this age group. An evidence-base for therapeutic decisions in elderly RA is limited as this age group is not well presented in clinical trials, due to age exclusions and comorbidities. Nevertheless, large real-world cohorts have shown that treatment of elderly RA is vital and that RA therapies are generally similarly effective and safe in elderly and young patients. Herein, we have discussed special considerations related to the risk profile of individual elderly patients. We then suggest a tailored approach that could be adopted in clinical practice, based on disease severity and the risk profile of elderly RA patients.