IN Japan, home to the world’s most rapidly aging society, managing rheumatoid arthritis (RA) in elderly patients has posed unique challenges for healthcare providers. With the increasing use of biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs), concerns around infection risk and malignancy have grown, particularly in older adults with multiple comorbidities. New insights from Japan’s FIRST registry, a 20-year prospective cohort study of 5,500 patients, offer valuable lessons for clinicians worldwide treating RA in aging populations.
The FIRST registry highlights a steady rise in the age of patients initiating b/tsDMARD therapy, accompanied by an uptick in comorbid conditions like cardiovascular disease, chronic kidney disease, and malignancy. These realities underscore the delicate balance between effective disease control and patient safety in older individuals.
Notably, the registry demonstrates that robust infection control strategies, including prophylaxis against pneumocystis pneumonia, screening for non-tuberculous mycobacteria, and vaccination programs, are associated with a reduced incidence of serious infections among elderly patients with RA on targeted therapies. Additionally, a proactive approach to malignancy management, such as computed tomography (CT) screening and multidisciplinary care, correlates with higher rates of early-stage cancer detection and fewer treatment discontinuations due to malignancy.
Despite these advances, challenges remain. Patients with prior exposure to b/tsDMARDs often show diminished response rates, highlighting the need for ongoing innovation in personalized treatment strategies. Moreover, although clinical remission rates have improved over the two-decade span of the registry, functional outcomes in elderly patients remain less than optimal.
As global populations age, the findings from Japan’s FIRST registry provide valuable insights into balancing efficacy and safety in RA treatment for older adults. With infection control and malignancy screening emerging as key components of care, these strategies could inform RA management approaches in other aging societies across the globe.
Reference: Takeuchi T et al. Targeted Therapies for Rheumatoid Arthritis in Super-Elderly Society: Insights From FIRST Registry, Japan. Rheumatology (Oxford). 2024;63:598–604.
