Alternative therapies for high-risk elderly rheumatic patients.

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.