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Antirheumatic drugs in older adults and polypharmacy issues

Antirheumatika bei älteren Erwachsenen und die Probleme der Polypharmazie

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Abstract

Older individuals experience various noninflammatory and autoimmune inflammatory rheumatic diseases. Given the increased incidence of rheumatic conditions in older adults, it is of great importance for healthcare providers to be aware of the potential benefits and risks of antirheumatic drugs. The present article aims to provide a comprehensive review regarding antirheumatic drug use in older patients, particularly by focusing on safety issues and polypharmacy. Antirheumatic medications include nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids and disease-modifying antirheumatic drugs (DMARDs), which comprise conventional synthetic DMARDs, targeted synthetic DMARDs and biological DMARDs. Due to the alteration in drug pharmacokinetics and pharmacodynamics in old people, antirheumatic drug efficiency and safety may be different than in the younger population. Polypharmacy and multimorbidity are other potential challenges to be faced during the treatment of older patients with rheumatic diseases. The current review also discusses the strategies to minimize adverse reactions due to antirheumatic drugs.

Zusammenfassung

Ältere Menschen leiden an verschiedenen nichtentzündlichen und autoimmun-entzündlichen rheumatischen Erkrankungen. Angesichts der zunehmenden Inzidenz rheumatischer Erkrankungen bei älteren Erwachsenen ist es für Gesundheitsdienstleister von großer Bedeutung, sich der potenziellen Vorteile und Risiken von Antirheumatika bewusst zu sein. Der vorliegende Beitrag soll einen umfassenden Überblick über die Anwendung von Antirheumatika bei älteren Menschen geben, insbesondere unter Berücksichtigung von Sicherheitsfragen und Polypharmazie. Antirheumatische Medikamente umfassen nichtsteroidale Antirheumatika (NSARs), Glukokortikoide und krankheitsmodifizierende Antirheumatika (DMARDs). Zu Letzteren zählen konventionelle synthetische DMARDs, zielgerichtete synthetische DMARDs und biologische DMARDs. Aufgrund der sich verändernden Pharmakokinetik und -dynamik von Medikamenten bei älteren Menschen können sich Wirksamkeit und Sicherheit der Antirheumatika gegenüber der jüngeren Bevölkerung unterscheiden. Polypharmazie und Multimorbidität sind weitere potenzielle Herausforderungen bei der Behandlung älterer Patienten mit rheumatischen Erkrankungen. In der aktuellen Übersicht werden auch die Strategien zur Minimierung unerwünschter Wirkungen der antirheumatischen Medikation erörtert.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Cukurova University, Adana, Turkey

    Ilke Coskun Benlidayi MD

  2. Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Yesim Gokce Kutsal MD

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  1. Ilke Coskun Benlidayi MD
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Correspondence to Ilke Coskun Benlidayi MD.

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Conflict of interest

I. Coskun Benlidayi and Y. Gokce Kutsal declare that they have no competing interests.

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For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Coskun Benlidayi, I., Gokce Kutsal, Y. Antirheumatic drugs in older adults and polypharmacy issues. Z Gerontol Geriat 55, 507–512 (2022). https://doi.org/10.1007/s00391-021-01907-6

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  • DOI: https://doi.org/10.1007/s00391-021-01907-6

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