Department of Rheumatology and Clinical Immunology, UMCG, University of Groningen, 9700 RB, Groningen, The Netherlands.
Nat Rev Rheumatol. 2013 Oct;9(10):604-13. doi: 10.1038/nrrheum.2013.92. Epub 2013 Jun 18.
The population of elderly individuals with rheumatoid arthritis (RA) is expanding, due mainly to increasing life expectancy. A variety of theories have been proposed to explain the ageing process, including accumulation of DNA damage and resultant changes in biological processes. Such changes can influence the development and/or course of disease. Furthermore, alterations in biological function determine the biological age-as opposed to chronological age-of an individual, which strongly influences their ability to cope with disease. Moreover, comorbidities are more frequent in elderly individuals. Together, these factors complicate treatment of disease and necessitate careful patient management. Indeed, although evidence from clinical trials suggests that DMARDs and biologic agents have good efficacy and are well tolerated in elderly patients with RA, such individuals are often undertreated and inadequately managed. Unfortunately, insufficient data are available for the development of evidence-based guidelines for this population, as elderly patients are often excluded from clinical trials owing to age restrictions or comorbidities. Thus, additional clinical studies in elderly patients are warranted, with treatment regimens tailored according to vitality or frailty parameters. This Review focuses on the pathophysiological aspects of ageing and their implications for the management of RA in elderly patients.
由于预期寿命的延长，类风湿关节炎 (RA) 老年患者的人数正在增加。人们提出了多种理论来解释衰老过程，包括 DNA 损伤的积累和由此导致的生物学过程变化。这些变化会影响疾病的发展和/或病程。此外，生物学功能的改变决定了个体的生物学年龄（与实际年龄相对），这强烈影响他们应对疾病的能力。此外，老年患者更容易出现合并症。所有这些因素都使疾病的治疗变得复杂，并需要仔细的患者管理。事实上，尽管临床试验的证据表明，DMARDs 和生物制剂在老年 RA 患者中具有良好的疗效且耐受性良好，但这些患者往往治疗不足且管理不当。不幸的是，由于年龄限制或合并症，针对这一人群的循证指南的开发缺乏足够的数据。因此，需要针对老年患者开展更多的临床研究，并根据活力或脆弱性参数制定治疗方案。本综述重点关注衰老的病理生理学方面及其对老年 RA 患者管理的影响。
