Should I reduce my RA medications as I get older at 68?

Question

Hi doctor,

I am a 68-year-old female with RA (rheumatoid arthritis) and have been relatively stable for a while, which honestly makes me wonder whether I still need the same medication doses I used in my 50s. Part of me wants fewer medications as I get older because of side effects and infection worries, but another part remembers how miserable flares used to be before treatment was working.

My rheumatologist has not suggested changes yet, but I keep wondering about it.

Do doctors usually consider reducing RA medications with age if disease activity stays controlled, or is long-term stability often a reason to keep treatment unchanged?

Please help

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and can understand your problem.

Usually, we do not stop medications, but in case you are in complete remission with no evidence of any articular symptoms for two successive whole years without steroid therapy and just on immunosuppressants, we consider it burnt RA (rheumatoid arthritis), and we can start gradual withdrawal of the immunosuppressant medications.

Unfortunately, this does not happen, as either many patients still keep complaining of prolonged morning stiffness or occasional joint pain, or we are unable to withdraw steroids below 5 milligrams.

Thus, most patients remain on the same regimen for life, but if any of the above situations occur, it is reasonable to consider stopping treatment and resuming regular follow-up.

Investigations to be done include:

CBC (complete blood count).
ESR (erythrocyte sedimentation rate).
CRP (C-reactive protein).
ALT (Alanine Aminotransferase).
AST (Aspartate Aminotransferase).
Sr Creatinine (serum creatinine).

Follow up every three months with a new clinical examination and laboratory investigations.

I am hoping that the above information was helpful for you.

If you have any other questions, feel free to contact me.

Thank you.