title: The influence of ageing on the development and management of rheumatoid arthritis.
abstract: The population of elderly individuals with rheumatoid arthritis (RA) is expanding, due mainly to increasing life expectancy. A variety of theories have been proposed to explain the ageing process, including accumulation of DNA damage and resultant changes in biological processes. Such changes can influence the development and/or course of disease. Furthermore, alterations in biological function determine the biological age-as opposed to chronological age-of an individual, which strongly influences their ability to cope with disease. Moreover, comorbidities are more frequent in elderly individuals. Together, these factors complicate treatment of disease and necessitate careful patient management. Indeed, although evidence from clinical trials suggests that DMARDs and biologic agents have good efficacy and are well tolerated in elderly patients with RA, such individuals are often undertreated and inadequately managed. Unfortunately, insufficient data are available for the development of evidence-based guidelines for this population, as elderly patients are often excluded from clinical trials owing to age restrictions or comorbidities. Thus, additional clinical studies in elderly patients are warranted, with treatment regimens tailored according to vitality or frailty parameters. This Review focuses on the pathophysiological aspects of ageing and their implications for the management of RA in elderly patients.
authors.affiliation: Department of Rheumatology and Clinical Immunology, UMCG, University of Groningen, 9700 RB, Groningen, The Netherlands.
authors.forename: Annemieke M H
authors.initials: AM
authors.lastname: Boots
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Maier
authors.forename: Piet
authors.initials: P
authors.lastname: Stinissen
authors.forename: Pierre
authors.initials: P
authors.lastname: Masson
authors.forename: Rik J
authors.initials: RJ
authors.lastname: Lories
authors.forename: Filip
authors.initials: F
authors.lastname: De Keyser
mesh_terms: D000375:Aging / Q000502:physiology*; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000503:physiopathology*; D001685:Biological Factors / Q000627:therapeutic use; D004249:DNA Damage / Q000502:physiology; D006801:Humans; D007107:Immune System / Q000503:physiopathology; D010641:Phenotype; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001685:Biological Factors