Course on Inflammatory Rheumatic Diseases in Older Adults

Society is getting older. In Hungary, people aged 65 and over now make up a quarter of the population, and their number has already overtaken that of young people under 18. The challenges of an ageing population are widely discussed in many fields, so it’s no surprise that we, as rheumatologists, decided to organise a course focusing on inflammatory musculoskeletal diseases in older patients.

The course was held within the Oftex framework on behalf of the Department of Rheumatology and Clinical Immunology at Semmelweis University, and I had the honour of putting together the programme as the organiser. 

Professor Klára Gadó opened the event with a presentation on the elderly patient as a whole person. Multimorbidity, complex medication regimens, side effects, drug interactions, and contraindications due to reduced organ function are all familiar challenges. But beyond these lies multicomplexity — the intertwining of medical, psychological, and social factors that shape an older patient’s condition. Caring for elderly patients requires close teamwork across multiple disciplines, with clearly defined therapeutic goals and a shared focus on what matters most to the patient.

Professor Emese Kiss then gave an excellent overview of giant cell arteritis, the most common vasculitis in older adults, covering both its pathogenesis and treatment options. New targeted therapies — JAK inhibitors—have proven effective in managing this disease. Although their use in older patients presents certain challenges, the benefits of inflammation control generally outweigh the risks. Both JAK inhibitors and IL-6 receptor inhibitors are approved and authorised for use in giant cell arteritis within the EU. However, in Hungary, NEAK reimbursement is currently available only through an individual equity (special case) request.

In my own talk, I discussed inflammatory joint diseases and their specific features in older patients — such as pronounced inflammation and frequent shoulder girdle involvement — and touched on the latest imaging and immunological findings, not limited to polymyalgia rheumatica (PMR). Unfortunately, methotrexate is still not reimbursed for PMR treatment in Hungary. The long-term side effects of steroid therapy are well known — though “gentle” at first, they can gradually worsen the condition of older patients over time.

Professor György Nagy, the Head of Department, spoke about the functional and anatomical changes of the ageing immune system, addressing inflammaging and the (so far) unavoidable immunosenescence. As we age, the pool of naïve immune cells declines while memory cells accumulate; meanwhile, the innate immune system remains in a constant low-level state of activation, known as autoinflammation. The result is a higher susceptibility to infections and tumours, while increased intestinal permeability allows the microbiome to influence a range of pathological processes.

In the afternoon, Associate Professor Ildikó Balogh and Zsuzsanna Kapitány from the Department of Physiotherapy at the Faculty of Health Sciences, Semmelweis University, spoke about the key principles of physiotherapy and the importance of staying active after 50. They recommended brisk walking for one hour three times a week, resistance training twice a week, and balance exercises twice a week. Those unfamiliar with the role of the lymphatic and capillary systems could learn more from the joint presentation given by Zsuzsanna Kapitány and myself.  

During the break, we showed a short film that some of our regular website visitors may already know. It was produced in 2022 for the Professional Continuing Education Programme and features our colleagues — physiotherapists, physical therapy specialists, Bemer specialists, and massage therapists — demonstrating their work with elderly patients in practice.

We all took away a great deal from the day. This lecture series truly deserves to be repeated — not only because of the importance of the topic, but also because of the outstanding quality of the presentations. We’re delighted to have already been invited to organise it again.