RECOMMENDATIONS FOR DRUG-THERAPY OF RHEUMATOID-ARTHRITIS IN ELDERLY PATIENTS

Drug therapy of rheumatoid arthritis in the elderly depends on the sev erity of the disease. Mild cases, which are usually of late onset and seronegative for rheumatoid factor, may respond to nonsteroidal anti-i nflammatory drugs (NSAIDs), low dosages of corticosteroids, or hydroxy chloroquine. Patients with more severe disease usually need the additi on of remittive agents such as methotrexate, gold or sulfasalazine. Pa tients with longer duration of the disease (earlier onset) frequently have refractory rheumatoid arthritis and may need combination therapy with multiple remittive agents. All medications for the treatment of r heumatoid arthritis are potentially toxic. The agents with the best ef ficacy/toxicity ratios appear to be methotrexate, hydroxychloroquine a nd sulfasalazine. The drug therapy of rheumatoid arthritis requires a delicate balance of risk and benefit. The treating physician should be familiar with the nature of the disease and with the currently availa ble medications.