Problems of antiarthritic therapy in the elderly.
Rheumatic diseases are prevalent in the elderly population, resulting in high morbidity caused mainly by lack of mobility. Consequently, the use of antirheumatic drugs in older persons is extensive. This review outlines some of the hazards encountered in the use of antirheumatic drugs in the elderly. Analgesics such as propoxyphene and acetaminophen are useful adjuncts to the treatment of arthritic pain, but propoxyphene has been associated with respiratory depression, and renal clearance of acetaminophen is reduced in elderly subjects. Salicylates may cause deafness, and like the other nonsteroidal anti-inflammatory drugs, may cause salt and water retention resulting in congestive cardiac failure. Phenylbutazone should not be used because of the risk of blood dyscrasia, and indomethacin has been reported as interfering with the antihypertensive effect of beta-blockers. Chloroquine levels may be raised in patients with impaired renal function, and there is increased risk of retinal damage with the drug in elderly subjects. Injectable gold compounds and penicillamine are not contraindicated in the elderly, because they are just as efficacious as in younger persons for the treatment of rheumatoid arthritis. Toxicity due to gold compound is not increased in the elderly, but skin rashes and abnormalities of taste do occur more commonly in elderly patients treated with penicillamine. Corticosteroids do not affect disease progression and therefore should be used only in acute severe disease for short periods of time. As in the younger population, treatment of gout in the elderly is dependent on renal function.(ABSTRACT TRUNCATED AT 250 WORDS)
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000493:Allopurinol / Q000009:adverse effects / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D001168:Arthritis / Q000188:drug therapy*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D002738:Chloroquine / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006046:Gold / Q000009:adverse effects / Q000627:therapeutic use; D006073:Gout / Q000188:drug therapy; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D010003:Osteoarthritis / Q000188:drug therapy; D010396:Penicillamine / Q000009:adverse effects / Q000627:therapeutic use; D011339:Probenecid / Q000009:adverse effects / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000493:Allopurinol; D006046:Gold; D002738:Chloroquine; D010396:Penicillamine; D011339:Probenecid; D008727:Methotrexate