Today, I will go on to explain: medication for rheumatoid arthritis in the elderly.
Rheumatoid arthritis in the elderly clinical drug considerations
1, non-steroidal anti-inflammatory painkillers
There are many kinds of NSAIDs, most of them are safe and effective, but there are also some side effects, the main side effects are peptic ulcer, renal insufficiency, central nervous system dysfunction.
(1) Elderly people may suffer from multiple diseases at the same time, such as hypertension, coronary heart disease, diabetes, etc. The frequency of combined medication increases and the function of each organ is poor. After starting the medication, regular monitoring of blood routine, liver and kidney function, urinary routine, etc. should be performed in order to adjust the medication in time.
(2) The elderly should try to choose non-steroidal anti-inflammatory analgesics with short half-life, such as loxoprofen.
(3) Long-term application of NSAIDs for elderly patients is more likely to cause gastrointestinal disorders, bleeding, tinnitus, kidney damage, water and sodium retention, induce and aggravate heart failure and other adverse reactions than that of young adults.
2.Slow-acting drugs and biological agents to improve the condition
(1) Methotrexate is an anchor drug for the treatment of rheumatoid arthritis. Some studies have shown that the use of low-dose methotrexate (MTX) 7.5 mg per week, combined with folic acid (both used at intervals) for the treatment of elderly patients with RA is safe.
MTX is mainly excreted through the kidneys, and some studies suggest that side effects are significantly increased in RA patients with creatinine clearance less than 62.6 ml/min. The factor closely related to the occurrence of side effects is the renal function status rather than the age at which MTX starts treatment. Other studies have shown that folic acid supplementation antagonizes the increase in plasma homocysteine levels caused by MTX treatment, thereby reducing the risk of cardiovascular disease.
(2) Retinopathy is a side effect of hydroxychloroquine, and special attention should be paid to individualizing its use in elderly patients. Hydroxychloroquine is safer in elderly patients at doses up to 6 mg/week with fewer adverse effects. However, the effect of retinal toxicity in elderly patients still requires regular fundus examination. The sedative methicarbamol has similar ocular toxicity to hydroxychloroquine and should be avoided in combination.
(3) Gastrointestinal reactions, lack of gastric acid, oral ulcers, transient aminotransferase elevation and granulocytopenia may occur in elderly people taking salazosulfapyridine (SSZ), but most of them are not serious and do not affect the continued use of the drug.
(4) The incidence of liver damage is higher with leflunomide (LEF) + MTX for RA in the elderly than with LEF or MTX alone, and the incidence of side effects is higher with MTX than with LEF.
The author’s personal experience: if the elderly RA suggests that the prognosis of the disease is poor indicators, such as multi-joint swelling and pain, high titers of rheumatoid factor, can be used in small doses MTX + small doses of LEF, while the combination of total peony glycosides (with hepatoprotective effect), this method of small doses, multi-target, the author’s clinical observation of good efficacy, the incidence of liver function abnormalities is low.
(5) Cyclosporine is not recommended for elderly patients because it can have obvious nephrotoxicity and the effect of single drug is not good.
(6) Biological agents are a major breakthrough in the field of rheumatism treatment in the past decade. Biological agents such as enalapril and infliximab have been used in clinical practice, but more adverse reactions occur in elderly patients, such as infection and induced lupus, which should be applied with caution.
3. How to use glucocorticoids
(1) Corticosteroids are fast-acting, and some scholars advocate low-dose (5~15mg) glucocorticosteroids as the preferred second-line drug for the treatment of elderly RA, whose main side effect is osteoporosis.
(2) However, the use of prednisone in RA is still controversial, especially in the elderly. It has been suggested that prednisone can be used for early control of disease activity, but try to apply small doses and short courses of treatment. Long-term use of prednisone should be supplemented with calcium and vitamin D. Patients with a history of osteoporosis or fracture should receive anti-osteoporosis treatment, such as estrogen replacement, diphosphonates, etc.
4.Phytomedicine
Because the elderly RA mostly have no reproductive requirements, so for patients who are not sensitive to traditional drugs to improve their condition, they can try to use Leigong Vine extract. The author has clinically found that some elderly RA patients, especially those with obvious joint swelling and pain, have good results with Leigong Vine. As an extract of Paeonia lactiflora, it has both the efficacy of treating rheumatoid arthritis and the hepatoprotective effect. In addition, most elderly people have constipation, and Paeonia lactiflora has diarrhea as a side effect, which is good for elderly RA patients to keep their intestines open.
Psychotherapy
Most RA patients, especially the elderly, are prone to depression or anxiety. Long-term emotional stress, anxiety, and depression can aggravate the endocrine and immune disorders of the body and promote the occurrence and development of arthritis, forming a vicious cycle.
Patients should understand their disease correctly, develop a positive attitude, and communicate more emotionally with their families and doctors. If the elderly are physically able, they can engage in some simple household work and develop some hobbies.
As family members of elderly patients, they should give patients emotional understanding and support, care and concern in life, encourage patients to complete simple affairs, accompany patients more, listen carefully and tolerate patients. At the same time, we should remind patients to have regular follow-ups and take medication on time and in the right amount.
The “incurable disease” becomes “curable disease”
Rheumatoid arthritis in the elderly has different characteristics from rheumatoid arthritis in young and middle-aged people in terms of clinical manifestations, diagnosis and treatment in Western medicine, and evidence-based treatment in Chinese medicine.
As modern medicine has updated its understanding of rheumatoid arthritis and its treatment, outcomes are gradually improving. Rheumatoid arthritis has been transformed from an “incurable disease” to a “treatable disease”. However, the key to relieving rheumatoid arthritis patients is early, standardized, and specialized medical treatment.