Management of treatment and renal function with Eldely RA patients
Keywords:
renal function,
elderly RA patients
2019 Volume 31 Issue 2 Pages 155-161
Details
2019 Volume 31 Issue 2 Pages 155-161
Life expectancy in Japan is increasing. Better treatment options have also improved the prognosis for patients with rheumatoid arthritis（RA）. Therefore, it is important to understand the direction of treatment for elderly-onset RA.
According to data from the Japan Society of Kidney Disease Guidelines 2012 for chronic kidney disease（CKD）, renal function declines with age in 1 out of 3 people aged 70-79 years and in 1 in 2 aged ≥ 80 years. Drugs that deteriorate renal function are difficult to use.
Japanese Society of Nephrology Association guidelines（2012）for CKD patients classify drug use by creatinine clearance（Ccr/min）＞b50, 10-50, and ＜ 10 on dialysis. Adalimumab, infliximab, etanercept, tocilizumab, salazosulfapyridine can be used to treat RA when Ccr/min is 10-50 or ＜ 10; methotrexate is prescribed for Ccr/min ＞b50. Because these are guidelines from 2012, they do not include new biological products that are currently used（e.g., JAK inhibitors）.
In the annual report of the Japanese Rheumatology Association from the NinJa database（2012-2014）, the group with eGFR ＜ 30 mL/min/1.73 m2 showed a significant decrease in the RA activity indices of DAS 28-ESR, DAS 28-CRP, CDAI, SDAI when compared with the groups of eGFR ＜ 30 to 60 mL/min/1.73 m2 and eGFR ＜ 60 to 100 mL/min/1.73 m2. In other words, patients with RA and CKD at stage G4（eGFR ＜ 15-29 mL/min/ 1.73 m2）and G5（eGFR ＜ 15 mL/min/ 1.73 m2）had poor control of disease activity. Based on these existing reports, it is important to discuss kidney function in elderly-onset RA and the selection of treatment for this population considering data from current studies in our department.
