Department of Rheumatology and NIHR Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Department of Rheumatology and NIHR Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Autoimmun Rev. 2020 Jun;19(6):102528. doi: 10.1016/j.autrev.2020.102528. Epub 2020 Mar 29.
The elderly rheumatoid arthritis (RA) population consists of both elderly-onset RA that manifests after the age of 60 and individuals diagnosed with RA early in life who age naturally to become members of this group. The elderly RA population is expanding due to both increased life expectancy and an increased incidence of elderly onset RA. Elderly onset RA seems to have a characteristic clinical pattern and perhaps biological profile different to that of early onset RA. The management of RA in elderly patients can be challenging, as robust treat-to-target approaches must be balanced against the adverse events due to increased comorbidities in old age. This produces a tendency to prefer less aggressive treatment in elderly RA patients in clinical practice. Despite the concerns about adverse events, there is limited evidence on the best way to approach RA in this population, as elderly patients are often not well presented in the clinical trials. Herein, we review the literature to assess the efficacy and safety of RA therapies in this age group. We then suggest a tailored approach that can be adopted in clinical practice, based on the disease severity and risk profiles of elderly RA patients.
老年类风湿关节炎（RA）患者群体包括发病年龄在 60 岁及以上的老年发病型 RA 患者，以及随着自然年龄增长而成为该群体成员的早年发病型 RA 患者。由于预期寿命的延长和老年发病型 RA 的发病率增加，老年 RA 患者群体正在不断扩大。老年发病型 RA 似乎具有不同于早年发病型 RA 的特征性临床模式和生物学特征。老年 RA 患者的管理具有挑战性，因为必须在因高龄而增加的合并症相关不良事件与强化达标治疗之间取得平衡，这导致在临床实践中倾向于对老年 RA 患者采用不那么激进的治疗方法。尽管存在对不良事件的担忧，但由于老年患者在临床试验中常常未得到充分体现，因此针对该人群的 RA 治疗方法的最佳方法仍缺乏证据。在此，我们对评估该年龄组 RA 治疗效果和安全性的文献进行了综述。然后，我们根据老年 RA 患者的疾病严重程度和风险特征，提出了一种可在临床实践中采用的个体化方法。
