Lakomek H-J, Schulz Christian
Klinik für Rheumatologie und Universitätsklinik für Geriatrie, Johannes Wesling Klinikum Minden, Hans-Nolte-Str. 1, 32429, Minden, Deutschland.
Bad Apotheke, Horn-Bad Meinberg, Deutschland.
Z Rheumatol. 2018 Jun;77(5):369-378. doi: 10.1007/s00393-018-0460-3.
Due to medical advances and the availability of efficient immunosuppressive therapies, the life-expectancy of people suffering from inflammatory rheumatic diseases is continuously increasing. In Germany, geriatric patients (definition: age older than 70 years combined with geriatric multimorbidity) affected, e. g. by rheumatoid arthritis (RA) frequently receive corticosteroids and less often biologic disease-modifying antirheumatic drugs (bDMARDs) and conventional DMARDs (cDMARDs), which is justified by additionally existing comorbidities and polypharmacy. Using geriatric typical assessments as well as detailed medication regimens the treatment risk of bDMARD and cDMARD administration can be properly evaluated. Current data on biological therapy in older patients with rheumatism support this recommendation. Following the "choosing wisely" initiative of the German Association of Internal Medicine the authors listed 5 positive and 5 negative recommendations concerning the pharmacotherapy of older patients suffering from rheumatism (e. g. RA) as practical guidance towards safer bDMARD and cDMARD treatment for geriatric RA patients.
由于医学进步以及高效免疫抑制疗法的可得性，患有炎性风湿性疾病的人的预期寿命在不断增加。在德国，受类风湿关节炎（RA）等影响的老年患者（定义：年龄超过70岁且患有老年多发病）经常接受皮质类固醇治疗，较少使用生物性改善病情抗风湿药（bDMARDs）和传统改善病情抗风湿药（cDMARDs），这是由额外存在的合并症和多种药物治疗所决定的。通过使用老年典型评估以及详细的用药方案，可以正确评估使用bDMARDs和cDMARDs的治疗风险。关于老年风湿性疾病患者生物治疗的当前数据支持这一建议。遵循德国内科协会的“明智选择”倡议，作者列出了关于老年风湿性疾病（如RA）患者药物治疗的5条正面和5条负面建议，作为对老年RA患者进行更安全的bDMARDs和cDMARDs治疗的实用指南。
