From the Guidelines
Autoimmune diseases typically do not improve with advancing age, and in fact, they often persist throughout life and may worsen over time. While some people experience periods of remission where symptoms decrease, aging generally brings additional challenges for those with autoimmune conditions. The immune system naturally undergoes changes with age (immunosenescence), which can actually complicate autoimmune disease management. Some conditions like rheumatoid arthritis may show altered symptoms with age, sometimes appearing less aggressive, but this doesn't necessarily indicate improvement of the underlying disease. Other autoimmune conditions like multiple sclerosis or lupus frequently require ongoing management regardless of age.
Treatment typically involves immunosuppressive medications such as corticosteroids (prednisone), disease-modifying antirheumatic drugs (methotrexate, hydroxychloroquine), or biologics (adalimumab, rituximab), which may need adjustment as patients age due to changing metabolism and increased risk of medication side effects. According to a study published in 2025 1, the management of autoimmune diseases, such as type 1 diabetes, requires ongoing monitoring and adjustment of treatments to prevent complications. Additionally, older adults with autoimmune diseases often face complications from comorbidities and may experience more severe effects from inflammation.
Regular medical follow-up remains essential throughout life to monitor disease activity and adjust treatments accordingly. As noted in a study from 2012 1, the prevalence of rheumatoid arthritis increases considerably with age, affecting approximately 6% of the white population older than 65 years. Furthermore, a study from 2018 1 highlights the importance of early diagnosis and treatment of autoimmune diseases to prevent long-term complications.
Key considerations in managing autoimmune diseases in older adults include:
- Monitoring for comorbidities and adjusting treatments accordingly
- Adjusting medication dosages to account for changing metabolism and increased risk of side effects
- Regular follow-up to monitor disease activity and adjust treatments as needed
- Considering the potential for immunosenescence to complicate disease management
- Being aware of the potential for autoimmune diseases to worsen over time, despite periods of remission.
Overall, autoimmune diseases require ongoing management and monitoring throughout life, regardless of age, and regular medical follow-up is essential to prevent complications and adjust treatments accordingly 1.
From the Research
Autoimmune Diseases and Age
- The relationship between autoimmune diseases and age is complex, and the available evidence does not provide a clear answer to whether these diseases improve with advancing age 2, 3.
- A study from 1999 notes that autoimmune diseases can be managed with immunosuppressive therapy, and while a cure is not possible, remission can be achieved in most cases 2.
- A more recent study from 2024 analyzed the global burden of autoimmune diseases in adolescents and young adults, finding that the incidence, prevalence, and mortality rates of these diseases vary significantly across different regions and countries 3.
- The study also found that the estimated global mortality rates of certain autoimmune diseases, such as rheumatoid arthritis, multiple sclerosis, and type 1 diabetes mellitus, declined from 1990 to 2021 3.
Treatment and Management
- The treatment and management of autoimmune diseases often involve a combination of medications, including immunosuppressive drugs and biologics 2, 4.
- A study from 2021 compared the effectiveness of triple therapy (methotrexate, sulfasalazine, and hydroxychloroquine) versus combination therapy (tumor necrosis factor inhibitor and methotrexate) in patients with rheumatoid arthritis, finding that the latter was associated with better clinical outcomes and lower medication discontinuation rates 4.
- Another study from 1999 investigated the use of combination therapy with methotrexate, vincristine, polyethylene-glycol conjugated-asparaginase, and prednisone in patients with refractory or recurrent acute lymphoblastic leukemia, finding that this regimen was active and well-tolerated 5.
Autoinflammatory Diseases
- Autoinflammatory diseases are a spectrum of disorders characterized by recurrent attacks of sterile inflammation, and can present in adulthood and even in the elderly 6.
- The pathophysiology of autoinflammatory diseases is complex, and involves rare mutations in genes that govern innate immunity, as well as environmental factors that trigger disease expression in genetically predisposed hosts 6.
- A review from 2024 emphasizes the importance of understanding the pathophysiology and classification of autoinflammatory diseases, and proposes a classification system for these conditions 6.