Therapeutic Recommendations for the Management of Older Adult Patients with Sjögren’s Syndrome

Soledad Retamozo, Chiara Baldini, Hendrika Bootsma, Salvatore De Vita, Thomas Dörner, Benjamin A. Fisher, Jacques-eric Gottenberg, Gabriela Hernández-molina, Agnes Kocher, Belchin Kostov, Aike A. Kruize, Thomas Mandl, Wan-fai Ng, Raphaèle Seror, Yehuda Shoenfeld, Antoni Sisó-almirall, Athanasios G. Tzioufas, Arjan Vissink, Claudio Vitali, Simon J. BowmanXavier Mariette, Manuel Ramos-casals, Pilar Brito-zerón

Research output: Contribution to journalArticlepeer-review

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Abstract

Primary Sjögren’s syndrome (SjS) is a systemic autoimmune disease most commonly diagnosed in middle-aged women. Although the disease can occur at all ages, it is diagnosed between 30 and 60 years of age in two-thirds of patients. In more than 20% of cases, the people are older than 65 years. In this review, we focus on the therapeutic management of primary SjS in older patients, following the recently published 2020 European League Against Rheumatism (EULAR) recommendations for the management of the disease with topical and systemic therapies. These recommendations are applicable to all patients with primary SjS regardless of age at diagnosis, although the therapeutic management in older patients requires additional considerations. Older patients are more likely to have pulmonary, liver, kidney, or heart-related comorbidities (even cognitive disturbances); caution is required when most drugs are used, including muscarinic agents, systemic corticosteroids and synthetic immunosuppressants. It is also important to monitor the use of eye drops containing steroids due to the increased risk of developing cataracts, a frequent ocular complication in the older population. In contrast, the majority of drugs that can be used topically (pilocarpine rinses, eye drops containing topical non-steroidal anti-inflammatory drugs (NSAIDs) or cyclosporine A, topical dermal formulations of NSAIDs) have shown an acceptable safety profile in older patients, as well as rituximab. A rigorous evaluation of the medical history of older patients is essential when drugs included in the EULAR guidelines are prescribed, with special attention to factors frequently related to ageing, such as polypharmacy, the existence of organ-specific comorbidities, or the enhanced susceptibility to infections.
Original languageEnglish
Pages (from-to)265-284
JournalDrugs & Aging
Volume38
Issue number4
Early online date2021 Feb 23
DOIs
Publication statusPublished - 2021

Subject classification (UKÄ)

  • Rheumatology and Autoimmunity

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