Question
I am a pediatrician who is not very familiar with Enbrel. My mother is 78 years old and has been taking NSAIDS for RA which she has had for over 30 years. Her wrist, elbows, and hands are severely deformed, but she has previously refused to try other forms of treatment, except prednisone which made her sick. Her doctor has suggested Enbrel. Considering her age and the probable condition of her joints due to longstanding RA, is it worth the risk?
Answer
As you know, it is impossible to make clinical assessements without seeing her, but let me make some general comments. In terms of benefits, I have been amazed that many patients with “endstage” or “burnt out” RA often will get a marked symtomatic improvement with the TNF agents such as Enbrel. Certainly patients with continuing inflammation, morning stiffness, joint swelling, elevated ESR will respond. There is also some evidence that the late stage RA will respond as well as early RA in terms of preventing x-ray damage. In terms of risk, all 78 year olds are not alike. If your mother has poor overall health status with multiple other problems, then she might be at increased risk for side effects. I know of no study that shows that age itself is a risk factor for problems. Ultimately its your mother’s quality of life that needs to be carefully looked at.
