Antirheumatic drugs in the elderly

Article Abstract:

Ideally, drug treatment protocols should be adjusted individually when treating elderly patients with arthritic diseases. How drugs are handled by body tissues may be critically different in many, but not all, elders, and drug effects may differ at target tissues. Research on this topic was presented in May 1990 at a British conference on the use of drugs in elderly patients with rheumatic diseases. The studies presented at the conference are reviewed in this article. Age-related differences in how drugs are handling by the body include relatively minor changes in absorption, possibly enhanced distribution and hence increased bioavailability, reduced metabolism, and generally reduced excretion. Variability in the extent of aging in elderly patients complicates the assessment of these parameters. Drug use differs among elders; many take an average of five drugs per day, and are at risk for drug interactions. Many patients have been found to benefit from treatments such as steroids, gold, and azathioprine, which modify rheumatic disease processes. For them, the use of non-steroidal anti-inflammatory drugs, such as aspirin, can be reduced. Lower body weight and decreased fluid levels may significantly contribute to increased drug toxicity in the elderly. Age-related changes in kidney function and consequent effects on naproxen excretion are reviewed. Drug compliance of elderly patients is often poor, and techniques to monitor and improve compliance are discussed. Patients' knowledge about drug treatments, their understanding of prescribed drugs, and familiarity with their diseases are also evaluated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aging, Aged, Elderly, Drugs, Demographic aspects, Drug therapy, Study and teaching, Dosage and administration, Geriatrics, Drug administration and dosage, Pharmacology, Pharmacokinetics

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The kidney in rheumatic diseases

Article Abstract:

Rheumatic diseases are characterized by inflammation, soreness and stiffness of muscles, and pain in joints and associated structures. Some rheumatic disorders, including systemic lupus erythematosus, polyarteritis nodosa, rheumatoid arthritis, and ankylosing spondylitis, can also affect the kidney and result in slight to severe impairment of kidney function. Studies have shown that the kidney disorders are not related to the use of non-steroidal anti-inflammatory drugs (NSAIDs) used to treat the disease, or to frequent urinary tract infections, elevated blood pressure, or severity of arthritis. Elderly patients often take NSAIDs with other medications such as diuretics, which are used to lower blood pressure through an effect on the kidney. This drug combination is often associated with decreased kidney function. However, a new NSAID called tenoxicam, combined with diuretics, does not alter kidney function. The best method for monitoring kidney function during NSAID therapy is currently unresolved. Creatinine clearance, a measure of kidney function, and levels of the blood protein beta-2-microglobulin in the urine have been suggested as indicators of rheumatic disease progression, but these measures have certain drawbacks. Another protein derived from cartilage, pyridinoline, may be more useful in monitoring the progression of rheumatic disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Evaluation, Causes of, Complications and side effects, Kidney diseases, Drug interactions, Kidney function tests

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Urinary glucaric acid excretion in rheumatoid arthritis: influence of disease activity and disease modifying drugs

Article Abstract:

The level of glucaric acid (GA) in the urine does not seem to be an appropriate marker for disease activity in patients with rheumatoid arthritis (RA). Doctors evaluated GA levels in 57 patients with RA at 0, 12, and 24 weeks during routine D-penicillamine, sodium aurothiomalate, or sulphasalazine treatment. The ratio of GA to creatinine increased with treatment. Patients treated with sulphasalazine had higher GA levels at week 12 than other treatment groups. GA levels did not seem to correspond to other measures of disease activity including C reactive protein, plasma viscosity, articular index, or platelet counts.

Rheumatoid arthritis

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