Management of inflammatory rheumatic conditions in the elderly

Lahaye, Clément; Tatar, Zuzana; Dubost, Jean‐Jacques; Tournadre, Anne; Soubrier, Martin

doi:10.1093/rheumatology/key165

Cited by 35 publications

(22 citation statements)

References 158 publications

(183 reference statements)

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“…Patients affected by IRD are at an increased overall risk of infection compared to the general population. [8][9][10] However, the infection risk varies and is highly dependent on the type and activity of the autoimmune disease, on comorbidities and on the intensity of the immunosuppressive/immunomodulatory treatment. 8 11 Most patients with IRD are treated with GC, csDMARDs, bDMARDs and tsDMARDs on a regular basis.…”

Section: Discussionmentioning

confidence: 99%

National registry for patients with inflammatory rheumatic diseases (IRD) infected with SARS-CoV-2 in Germany (ReCoVery): a valuable mean to gain rapid and reliable knowledge of the clinical course of SARS-CoV-2 infections in patients with IRD

Hasseli

Müeller-Ladner

Schmeiser³

et al. 2020

RMD Open

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ObjectivesPatients with inflammatory rheumatic diseases (IRD) infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be at risk to develop a severe course of COVID-19. The influence of immunomodulating drugs on the course of COVID-19 is unknown. To gather knowledge about SARS-CoV-2 infections in patients with IRD, we established a registry shortly after the beginning of the pandemic in Germany.MethodsUsing an online questionnaire (www.COVID19-rheuma.de), a nationwide database was launched on 30 March 2020, with appropriate ethical and data protection approval to collect data of patients with IRD infected with SARS-CoV-2. In this registry, key clinical and epidemiological parameters—for example, diagnosis of IRD, antirheumatic therapies, comorbidities and course of the infection—are documented.ResultsUntil 25 April 2020, data from 104 patients with IRD infected with SARS-CoV-2 were reported (40 males; 63 females; 1 diverse). Most of them (45%) were diagnosed with rheumatoid arthritis, 59% had one or more comorbidities and 42% were treated with biological disease-modifying antirheumatic drugs. Hospitalisation was reported in 32% of the patients. Two-thirds of the patients already recovered. Unfortunately, 6 patients had a fatal course.ConclusionsIn a short time, a national registry for SARS-CoV2-infected patients with IRD was established. Within 4 weeks, 104 cases were documented. The registry enables to generate data rapidly in this emerging situation and to gain a better understanding of the course of SARS-CoV2-infection in patients with IRD, with a distinct focus on their immunomodulatory therapies. This knowledge is valuable for timely information of physicians and patients with IRD, and shall also serve for the development of guidance for the management of patients with IRD during this pandemic.

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Section: Discussionmentioning

confidence: 99%

National registry for patients with inflammatory rheumatic diseases (IRD) infected with SARS-CoV-2 in Germany (ReCoVery): a valuable mean to gain rapid and reliable knowledge of the clinical course of SARS-CoV-2 infections in patients with IRD

Hasseli

Müeller-Ladner

Schmeiser³

et al. 2020

RMD Open

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“…Patients with EO-rheumatoid arthritis (EO-RA) have higher serum interleukin-6 levels and lower serum TNFα levels than patients with NEO-RA, and high levels of TNFα are associated with higher risk of hospitalization and death 26 – 28 . Furthermore, anti-TNF treatment for EO-RA seems to be less effective than for NEO-RA 26 .…”

Section: Discussionmentioning

confidence: 99%

Elderly onset age is associated with low efficacy of first anti-tumor necrosis factor treatment in patients with inflammatory bowel disease

Amano

Shinzaki

Asakura

et al. 2022

Sci Rep

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The outcomes of patients with elderly onset (EO) inflammatory bowel disease (IBD) treated with anti-tumor necrosis factor (TNF) remains uncertain. The present study evaluated the efficacy and safety of anti-TNF treatment for bio-naïve EO-IBD. Elderly patients were defined as those 60 years and older, and further divided into those with EO (Elderly-EO) and those with non-elderly onset (Elderly-NEO). A total of 432 bio-naïve patients were enrolled in this multicenter observational study, comprising 55 with Elderly-EO (12.7%), 25 with Elderly-NEO (5.8%), and 352 under age 60 (Non-elderly, 81.5%). After 52 weeks of anti-TNF treatment, clinical and steroid-free remission rates were significantly lower in Elderly-EO than in Non-elderly (37.7% and 60.8%; P = 0.001, and 35.9% and 57.8%; P = 0.003, respectively), and comparable between Elderly-NEO and Non-elderly. Multivariate analysis revealed that elderly onset was a significant factor for both clinical remission (OR, 0.49, 95% CI 0.25–0.96) and steroid-free remission (OR, 0.51, 95% CI 0.26–0.99) after 52 weeks of anti-TNF treatment. The rate of cumulative severe adverse events was significantly higher in Elderly-EO than in Non-elderly (P = 0.007), and comparable between Elderly-NEO and Non-elderly. In conclusion, anti-TNF treatment for bio-naïve EO-IBD may be less effective and raise safety concerns.

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“…Current guidelines suggest that ANCA-positive patients need at least 5 years of treatment. Rheumatologists are developing a personalised approach to immunosuppression in elderly people; other specialists, including neurologists, should also consider an integrated therapeutic strategy to limit inappropriate prescribing and to refine the prognosis by identifying comorbidities 9…”

Section: Discussionmentioning

confidence: 99%

Epstein–Barr virus associated CNS lymphoproliferative disorder after long-term immunosuppression

Lee

Bridges²,

Lloyd

et al. 2019

Pract Neurol

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The incidence of Epstein–Barr virus (EBV)associated lymphoproliferative disorders has increased with greater use of immunomodulatory therapies. We present a woman who developed subacute cognitive decline and unilateral weakness while taking long-term mycophenolate mofetil for granulomatosis with polyangiitis; her postmortem brain histopathology confirmed an EBV-driven lymphoproliferative disorder. Clinicians must have a high index of suspicion for EBV-driven lymphoma in people taking long-term immunosuppression who develop new neurological problems. We review the role of mycophenolate mofetil in EBV-driven lymphoproliferative disorders, and discuss checking EBV status in all patients starting immunosuppression and in older people already taking immunosuppression.

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Management of inflammatory rheumatic conditions in the elderly

Cited by 35 publications

References 158 publications

National registry for patients with inflammatory rheumatic diseases (IRD) infected with SARS-CoV-2 in Germany (ReCoVery): a valuable mean to gain rapid and reliable knowledge of the clinical course of SARS-CoV-2 infections in patients with IRD

National registry for patients with inflammatory rheumatic diseases (IRD) infected with SARS-CoV-2 in Germany (ReCoVery): a valuable mean to gain rapid and reliable knowledge of the clinical course of SARS-CoV-2 infections in patients with IRD

Elderly onset age is associated with low efficacy of first anti-tumor necrosis factor treatment in patients with inflammatory bowel disease

Epstein–Barr virus associated CNS lymphoproliferative disorder after long-term immunosuppression

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