Treatment for Elderly-Onset Rheumatoid Arthritis
If you are older than 60 years of age and develop symptoms of rheumatoid arthritis (RA), you may have what is called late-onset rheumatoid arthritis, or elderly-onset rheumatoid arthritis (EORA). Your doctor can diagnose EORA by your symptoms, a physical exam, special X-rays, and blood tests.
One of the problems with treating EORA is that older people may be more sensitive to the drugs used to treat RA. On top of that, as you get older you may have other medical problems, and RA drugs may need to be added to the drugs you are already taking. That could mean more drug interactions and side effects. Since liver function and kidney function may have significantly declines, older people may also clear drugs from their systems differently than younger people. All these factors may make it difficult for you and your doctor to treat EORA.
Treatment Options for EORA
There is good news about your treatment. Most of the same drugs used to treat younger people with RA will work for you and the side effects can be managed. The goals of treatment are the same: Reduce swelling, reduce pain and stiffness, and stop the disease from getting worse. In many cases, these drugs can put your EORA into remission for long periods of time. This means that your body shows no signs of the disease and you have few or no symptoms.
Here are some of the treatment options your doctor may suggest:
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be used to quickly ease swelling, stiffness and pain. Ask your doctor how to recognize the side effects of high-dose NSAIDs, such as stomach upset and stomach bleeding. You also need to be careful if you have heart or kidney problems.
Corticosteroid drugs, such as prednisone, may also be used for quick relief. Corticosteroids may put you at greater risk for osteoporosis (bone weakness). You can reduce your risk by taking low doses and monitoring your bone health through bone density scans.
Methotrexate is the drug that most people with RA can tolerate best. You may take it along with your steroid and NSAID. Methotrexate is used for long-term relief of RA. It is called a disease-modifying anti-rheumatic drug (DMARD). You may need to be extra careful using methotrexate if you have lung or kidney problems.
If you need more relief, adding another DMARD to methotrexate may be the next step. Other DMARDs that may be used with methotrexate include hydroxycholoroquine and sulfasalazine. Adding more DMARDs is usually safe as long as your health is checked regularly. This is usually done with physical exams and blood tests.
Biologic therapies are newer RA drugs. They have become available over the last 10 years. These drugs act like natural substances in your blood to block pain and swelling. Most biologic drugs can be used in combination with other RA drugs. These drugs may increase your chance of getting infections, such as pneumonia. However, their benefit may outweigh the risk of infection. As long as your doctor is watching you closely they should be safe to take.
The Bottom Line on EORA Treatment
RA when you are older than 60 years can be managed. In the past, many doctors were concerned about the side effects of RA drugs in older people. Some people may have been undertreated. Today, studies show that people with EORA do well with most RA drugs and that they should be treated early with combinations of DMARD drugs and biologic therapies when needed.
Work closely with your doctor. Discuss all the benefits and risks of treatment. Make sure you know what side effects to look out for. With the right treatment plan, your disease may go into remission.
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- Missed Opportunities in the Treatment of Elderly Patients With Rheumatoid Arthritis. Rheumatology, May 28, 2009, Vol. 48, Issue 8, pages 906-10. http://rheumatology.oxfordjournals.org/content/48/8/906.full
- Rheumatoid Arthritis Treatment. Johns Hopkins Arthritis Center. http://www.hopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/rheum_treat.html