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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Soubrier, Martin Mathieu, Sylvain Payet, Sarah Dubost, Jean-Jacques Ristori, Jean-Michel |
| Description | Country affiliation: France Author Affiliation: Soubrier M ( Service de Rhumatologie, hôpital G.-Montpied, BP 69, 63003 Clermont-Ferrand, France. msoubrier@chu-clermontferrand.fr) |
| Abstract | The treatment of elderly-onset rheumatoid arthritis pursues the same objectives as in younger patients: to control the clinical manifestations, to prevent structural damage, to preserve function, and to decrease excess mortality. In the elderly, the presence of co-morbidities and increased rate of drug-related adverse effects raise specific therapeutic challenges. Nonsteroidal anti-inflammatory drugs are associated with cardiovascular, gastrointestinal, and renal adverse events. The role for corticosteroid therapy remains controversial. Although glucocorticoids provide a short-term decrease in clinical activity and probably a medium-term decrease in structural damage, these benefits are offset by numerous adverse effects. Methotrexate was effective in clinical trials and observational studies and did not produce a higher adverse event rate compared to younger patients, provided renal function was normal. Data on the efficacy of TNFalpha antagonists in therapeutic trials are available only for etanercept. Disease activity decreased and function improved. The adverse event rate was higher in older patients, but this was also true of the conventional drugs used as comparators. Registry data confirm that TNFalpha antagonist therapy is effective in RA. An increased rate of infections was found only in some registries. To combat the 2-fold cardiovascular risk increase associated with RA, disease activity should be stringently controlled and all cardiovascular risk factors managed aggressively. |
| File Format | HTM / HTML |
| ISSN | 1297319X |
| Issue Number | 4 |
| Volume Number | 77 |
| e-ISSN | 17787254 |
| Journal | Joint Bone Spine |
| Language | English |
| Publisher | Elsevier |
| Publisher Date | 2010-07-01 |
| Publisher Place | France |
| Access Restriction | One Nation One Subscription (ONOS) |
| Subject Keyword | Discipline Rheumatology Antirheumatic Agents Therapeutic Use Arthritis, Rheumatoid Drug Therapy Aged Aged, 80 And Over Adverse Effects Complications Cardiovascular Diseases Epidemiology Humans Risk Factors Journal Article Review |
| Content Type | Text |
| Resource Type | Article |
| Subject | Rheumatology |
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