Besonderheiten rheumatischer Erkrankungen im Alter

Zusammenfassung

Aufgrund der erhöhten Lebenserwartung und anhand epidemiologischer Daten zeigt sich eine Zunahme rheumatische Erkrankungen älterer Menschen. Diese Population ist durch ein erhöhtes Risiko für kardiovaskuläre, infektiöse, neoplastische und iatrogene Komplikationen betroffen. Multimorbidität in Verbindung mit Polypharmazie und progredienten funktionellen Defiziten haben erheblichen Einfluss auf den klinischen Verlauf und die Therapieentscheidungen bei Altersvarianten rheumatischer Erkrankungen. Der Altersprozess des Immunsystems ist geprägt von Immunseneszenz und „Inflammaging“ mit der Folge eines erhöhten Risikos für Infektionen und Tumorerkrankungen, eines verringerten regenerativen Potentials und einer verstärkten unspezifischen Entzündungskonstellation. Neben den wenigen alterstypischen rheumatischen Erkrankungen wie der Polymyalgia rheumatica gibt es Altersformen rheumatischer Erkrankungen, die hinsichtlich der klinischen Symptomatik, der Pathophysiologie, Labordiagnostik und der Prognose Besonderheiten aufweisen. Atypische Krankheitsverläufe und Mischbilder mit degenerativen oder anderen entzündlichen Erkrankungen sind nicht ungewöhnlich. In der Übersichtsarbeit werden die speziellen Altersvarianten verschiedener rheumatischen Erkrankungen vorgestellt. Ältere Patienten mit rheumatischen Erkrankungen sind durch die derzeitige Studienlage nicht adäquat erfasst. Ein wesentlicher Schwerpunkt künftiger klinisch-rheumatologischer Forschung sollte die stärkere Einbeziehung dieser Patienten sein, um durch angepasste und integrative Therapiekonzepte Morbidität und Mortalität zu reduzieren.

Abstract

Epidemiological data suggests a global rise of rheumatic diseases in elderly individuals due to increased life expectancy. Unfortunately, the life span is not synonymous with the health span, so this population is significantly affected by an increased risk for cardiovascular, malignant, infectious and iatrogenic complications. Comorbidities, polypharmacy and progressive functional decline culminating in geriatric syndromes have an impact on the clinical course and therapeutic strategy in older patients with rheumatic diseases. The aged immune system is compromised by immunosenescence and inflammaging leading to attenuated protective immunity, resilience and regenerative potential as well as increased systemic inflammation. In addition to the few age-related rheumatic diseases such as polymyalgia rheumatica, there are age-specific forms of rheumatic diseases with unique characteristics regarding clinical symptoms, pathophysiology, laboratory diagnostics, and prognosis. Elderly-onset rheumatic diseases often exhibit distinct clinical, pathophysiological and diagnostic features. Atypical variants and overlapping manifestations with degenerative or inflammatory diseases complicate the diagnostic attribution. This review provides a comprehensive overview and presents specific aspects of the most relevant rheumatic diseases in the elderly.

Schlüsselwörter

rheumatische Erkrankungen - Alter - late-onset - Altersvarianten - LORA

Keywords

rheumatic diseases - elderly - old - multimorbidity - late-onset

Publikationsverlauf

Artikel online veröffentlicht:
09. August 2024

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