Pharmacological Intervention in Older Patients with Rheumatoid Arthritis

Abstract

Despite the rather pessimistic outlook regarding the long term effects of pharmacological treatment of patients with rheumatoid arthritis (RA), there is no doubt that drug interventions can affect quality of life (QOL). The disease has a significant impact upon physical, psychological and social function, and QOL optimisation should cover all these dimensions. Swelling of joints and pain are important manifestations in assessing RA since these may result in sleep disturbances as well as depressed mood. This might be particularly significant for older persons with RA. Outcome parameters of RA can be divided into short, intermediate and long term. The long term results are quite disappointing with regard to disability and premature death. However, more intermediate outcome measures related to QOL might improve after pharmacological interventions. Patient preferences and expectations with regard to the outcome of pharmacological interventions are important parameters to assess. When assessing older patients with RA with QOL instruments, it is recommended that questionnaires are fairly short and easy to complete. Adverse effects of pharmacological interventions are important factors to monitor in QOL assessment in older patients with reduced remaining life span.

Factors affecting emotional instability in female rheumatoid arthritis outpatients with limited functional disorder

“…There has been a report 24 that showed a transient quality of life improvement in older RA patients due to the use of drugs, and the results of the present study also showed that the use of drugs can improve emotional instability. There has been a report 24 that showed a transient quality of life improvement in older RA patients due to the use of drugs, and the results of the present study also showed that the use of drugs can improve emotional instability.…”

First Patient-Centered Drug Information Service in Germany—A Descriptive Study

“…27 Besides this, early detection and intervention of medication errors or adverse drug reactions may save follow-up costs and improve patients’ quality of life. 28–30…”

Psychological Factors Associated with Response to Treatment in Rheumatoid Arthritis

“…This will forcibly have a high impact on the results of treatment in clinical practice. Expectations regarding the effects and side effects of therapy are essential for successful adherence [135]. Female gender, middle age, busy lifestyle, cognitive deficits, depression, higher income, and employment status have all been associated with nonadherence [136,137].…”

“…Psychological aspects of the prescribing physician and divergence between patients and physicians also play a role. For example, patients with early RA were less reluctant to accept combination therapy with conventional DMARDs and biologics than rheumatologists [133][134][135][136], and a study analyzing the European League Against Rheumatism Recommendations on the management of glucocorticoid therapy demonstrated important discrepancies between patients' and rheumatologists' perspectives that might negatively affect the implementation of the recommendations [137]. Such beliefs and divergence need to be addressed, as they may unduly interfere with the physician's selection of therapy and with the patient's commitment to the strategy.…”