title: Treatment strategy of elderly rheumatoid arthritis.
abstract: Since the general population is ageing, the number and the mean age of elderly patients of rheumatoid arthritis (RA) have increased. Elderly RA is classified into two clinical subsets, younger onset elderly RA (YORA) and elderly-onset RA (EORA). In the past literature, onset after 60 years of age is mainly adopted as the classical definition of EORA. Elderly-YORA patients, in addition to disease-modifying antirheumatic drugs, sometimes need analgestics, joint surgery and rehabilitation taking into account their bone destruction and their activities of daily living. Early phase EORA patients should be treated using the treat-to-target strategy, although low disease activity is the realistic goal due to their co-morbidities, patient factors and drug-related risks. Methotrexate (MTX) is the anchor drug in the treatment of EORA. It should be started at low dose (2-4 mg/day) and if tolerated, the dosage is carefully increased. In the case of renal dysfunction or dementia, and MTX is intolerable, biologics monotherapy could be a choice of treatment. Tapering of glucocorticoid, as far as possible, is needed because it is one of the risk factors of infection. Treatment of super-aged RA patients is a future agenda.
authors.affiliation: Department of Internal Medicine, Japan Organization of Occupational Health and Safety, Hokkaido Spinal Cord Injury Center.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takeda
mesh_terms: D000203:Activities of Daily Living; D000284:Administration, Oral; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000145:classification / Q000453:epidemiology / Q000534:rehabilitation / Q000628:therapy*; D001685:Biological Factors / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage / Q000627:therapeutic use; D007596:Joints / Q000601:surgery; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use; D019637:Orthopedic Procedures
chemical_list: D000700:Analgesics; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D001685:Biological Factors; D005938:Glucocorticoids; D000069285:Infliximab; C502936:tocilizumab; D008727:Methotrexate