Letter: DMARDS are not always the sole choice in RA in the elderly

Dear Editor

The Heart paper on NSAIDs and heart failure (HF) risk contains some oddities, not least the fact that the increased risk described is not seen in clinical practice.

One doctor's admission for HF is another's challenge for management in the community, and we all know about the high prevalence of HF in the elderly.

Given that we all know that NSAIDs can be dodgy in old folks, and that we already watch for renal dysfunction, bleeding and ankle oedema, does it not seem odd that none of us appears to have noticed a significant increase in HF risk?

Further oddities include failure to find any duration or dose-effect in the study. Further study is, as all good British Journal of General Practice papers conclude, called for.

Dr Ahmet Fuat's statement that all RA patients should be on disease-modifying drugs (DMARDS) and get by without NSAIDs is a long way divorced from reality.

I have yet to see a DMARD that works for every RA patient - part of the reason why we have several different DMARDs no doubt.

And let us not discuss the patchy availability and use of drugs such as infliximab.

Dr Declan Fox, Newtonstewart, County Tyrone.

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