[Recent aspects of antirheumatic therapy in the elderly]

Consequences have to be derived in respect to the antirheumatic treatment from recent withdrawals of several non-steroidal anti-inflammatory drugs (NSAID). This especially applies for elderly patients with reduced renal function. The dosage has to be carefully adjusted to the individual problems of the patient. No attempts should be made to achieve a completely pain-free state by use of highest dosages: the lower the dose maintaining the patient's mobility, the safer the therapy. NSAID with long elimination half-life time carry a special risk of adverse effects for the elderly due to accumulation. Reduced renal function of the elderly may also result in hypertension and heart failure. Combination of NSAID with glucocorticoids may enhance the antiinflammatory effect, but also causes an increase of adverse effects. Therefore, the combined use appears to be justified only in special situations of severe inflammatory activity no sufficiently controlled by NSAID in which the glucocorticoids are used in the lowest effective dose applied according to the circadian rhythm. The duration of treatment is to be limited, since the adverse effects of glucocorticoids increase with time.