Drug management of arthritis in the elderly

Rheumatic disorders are common in the ageing population requiring the use of DMARDs and immunosuppressive therapy as with younger patients. Indications for therapy are approximately the same in both groups, but toxic side-effects are probably more common in the elderly necessitating close supervision of indications and drug requirements. Local injection techniques The practice of local injection of corticosteroid in musculo-skeletal disorders is widespread. The literature on comparative efficacy between different preparations is scanty. These techniques can give significant relief in rheumatoid arthritis, osteoarthritis, sero negative arthropathies, crystal induced arthritis and many soft tissue lesions. Severe joint and soft tissue lesions are common in the elderly. In these patients even a small loss of physical function may have a markedly detrimental effect on independence. Such lesions should therefore be actively sought and vigorously treated. Often a simple, rapidly acting, local corticosteroid injection is preferable to a prolonged course of either NSAIDs or physiotherapy. In general, such injections should not be used if the diagnosis is uncertain, or there is any suspicion of infection, or if there has been a previous severe local reaction. Injections that are becoming too regular mean that the technique has not proved successful and other therapies should be sought. In performing the injections, antisepsis should be scrupulous and a 'no-touch' technique used. Accuracy of needle placement is necessary for good results. Injections should not be given against pressure as this generally means incorrect sitting. Some systemic absorption does occur.(ABSTRACT TRUNCATED AT 250 WORDS)