Tratamiento de la artritis reumatoide del anciano

Abstract

In the international literature, rheumatoid arthritis (RA) of the elderly is considered to be that affecting persons aged over 65 years. Currently, this population comprises most series of patients with RA and includes both persons with disease onset after this age and those with chronic RA developing years previously. RA with onset after the age of 65 is called elderly onset rheumatoid arthritis (EORA) and shows slightly different clinical manifestations from RA developing in younger individuals. However, both the therapeutic arsenal used and the objectives proposed for the treatment of RA of the elderly differ little from those employed in younger patients. The same therapies are employed but are adapted to the particular characteristics of this population, such as pharmacokinetic changes, comorbidities, and an increased susceptibility to infection. The aim of treatment —disease remission— is the same as in younger patients. Excessive caution in the use of drugs may lead to suboptimal treatment, especially in the initial stages when the disease is more active, and leave irreversible sequelae. Treatment should be individually tailored to the patient's characteristics, with adequate monitoring. Traditionally, elderly patients more frequently received glucocorticoids and were rarely treated with disease-modifying antirheumatic drugs (DMARDs) or biological agents. People over 65 years are underrepresented in clinical trials but there seem to be no particular contraindications to the use of methotrexate or anti-tumor-necrosis factor (anti-TNF) agents in this population. Data from national registries in several countries have confirmed the similar safety and efficacy of DMARDs and anti-TNF agents in elderly patients. Data on the administration of other biological agents in the elderly are limited. Rheumatologists should be aware of the higher risk of adverse events in this population, especially when using non-steroidal anti-inflammatory drugs, and should recognize the need to adjust treatment to the individual characteristics and comorbidities of each patient.