Lequesne M
Rheumatology Service, Hôpital Léopold-Bellan, Paris, France.
Gerontology. 1988;34 Suppl 1:33-41. doi: 10.1159/000212985.
The main high-risk conditions among elderly rheumatic patients are peptic ulcer, renal or hepatic insufficiencies, and bleeding problems (either spontaneous or iatrogenic). Because the incidence of these conditions is significant, elderly patients should be monitored for them regularly. Although nonsteroidal antiinflammatory drugs (NSAIDs) generally are avoided, these agents can be used in selected patients. High-risk elderly rheumatoid arthritis patients can be given prednisone and a carefully chosen disease-modifying antirheumatic drug. Although analgesics can be used instead of NSAIDs, their efficacy is poor. Local therapy, i.e. intraarticular injections, and even surgery are good alternative resources. In Europe, patients with osteoarthritis are often treated with NSAIDs. High-risk elderly patients may receive sufficient relief with analgesics. If relief is not adequate, hip or knee total prosthesis procedures must be performed earlier than would normally be done.
老年风湿性疾病患者的主要高危情况包括消化性溃疡、肾或肝功能不全以及出血问题（自发性或医源性）。由于这些情况的发生率较高，应对老年患者进行定期监测。虽然通常应避免使用非甾体抗炎药（NSAIDs），但在特定患者中也可使用。高危老年类风湿关节炎患者可给予泼尼松及精心挑选的改善病情抗风湿药。虽然可用镇痛药替代NSAIDs，但它们的疗效较差。局部治疗，即关节内注射，甚至手术都是很好的替代方法。在欧洲，骨关节炎患者常使用NSAIDs治疗。高危老年患者使用镇痛药可能会获得足够的缓解。如果缓解不充分，则必须比通常更早地进行髋关节或膝关节全置换手术。
