[Which kind of structures and facilities are needed for the care of elderly patients with rheumatic diseases?]

[Rehabilitation in rheumatic diseases and osteoporosis-a multidisciplinary task]

Advances in medications and changes in therapeutic options have significantly reduced limitations in functional capacity and quality of life for patients with rheumatic diseases and osteoporosis, but there is still a large number of patients in whom the diseases do not take the desired course. Older rheumatic patients also often have comorbidities that require a multidisciplinary and multimodal approach to therapy. Rehabilitation measures are, therefore, an important part of the treatment concept for these patients in order to maintain their functional health, social participation, and, in the case of those who are still working, in particular their gainful employment. They can help to limit sequelae, preserve existing functions, reduce pain, and maintain the quality of life of those affected. The article aims to provide an overview of the rehabilitative therapy concept and the level of evidence for individual forms of therapy.

[Characteristics of pharmacotherapy in older patients with rheumatism]

Due to medical advances and the availability of efficient immunosuppressive therapies, the life-expectancy of people suffering from inflammatory rheumatic diseases is continuously increasing. In Germany, geriatric patients (definition: age older than 70 years combined with geriatric multimorbidity) affected, e. g. by rheumatoid arthritis (RA) frequently receive corticosteroids and less often biologic disease-modifying antirheumatic drugs (bDMARDs) and conventional DMARDs (cDMARDs), which is justified by additionally existing comorbidities and polypharmacy. Using geriatric typical assessments as well as detailed medication regimens the treatment risk of bDMARD and cDMARD administration can be properly evaluated. Current data on biological therapy in older patients with rheumatism support this recommendation. Following the "choosing wisely" initiative of the German Association of Internal Medicine the authors listed 5 positive and 5 negative recommendations concerning the pharmacotherapy of older patients suffering from rheumatism (e. g. RA) as practical guidance towards safer bDMARD and cDMARD treatment for geriatric RA patients.