Treatment considerations in the elderly rheumatic patient

The elderly represent a large subset of the rheumatic population, some of whom have experienced musculoskeletal disease since early life or middle age, whereas others are affected for the first time in their later years. They may be afflicted with a variety of musculoskeletal disorders, some of which occur almost exclusively in elderly individuals. Advancing age may be accompanied by failure of the musculoskeletal system and other major organs. As a result, elderly patients frequently receive concurrent treatment with several pharmacologically active compounds, which increases the potential for significant adverse drug-drug interactions. In addition, the elderly may be less tolerant of certain classes of compounds, including some antirheumatic drugs, necessitating careful drug selection and patient monitoring. Diagnostic and therapeutic decision making may be impeded by the patient's inability to recall completely and accurately important historical details, particularly those relating to drug therapy. Treatment objectives may be compromised further by poor compliance, and adequate follow-up made more difficult by the patient's lack of mobility and declining independence. Successful management of the elderly rheumatic patient, therefore, requires an accurate clinical assessment, comprehensive evaluation of major organ functioning, identification of potential drug-drug interactions, appropriate selection of anti-rheumatic drugs and other treatment modalities, effective doctor-patient communication, and careful monitoring for both beneficial and adverse responses to therapy.