Treatment of older adult patients diagnosed with rheumatoid arthritis: Improved but not optimal

Abstract

Objective The National Committee on Quality Assurance has determined that all patients with rheumatoid arthritis (RA) should be treated with disease‐modifying antirheumatic drugs (DMARDs). Our objective was to determine the rate and predictors of DMARD use in a cohort of elderly patients with RA. Methods We analyzed health care utilization data for 5,864 Medicare beneficiaries with RA who also participated in a state‐run pharmaceutical benefit program in Pennsylvania. Patients with RA were defined as those with at least 3 diagnoses of RA (International Classification of Diseases, Ninth Revision code 714.xx) at least 1 week apart who were enrolled in these programs for at least 12 months during 1995–2004. Multivariate logistic regression was used to assess predictors of synthetic or biologic DMARD use in the 12 months after cohort entry. Results Thirty percent of patients filled a DMARD prescription during 12 months of followup. Frequency of DMARD use increased steadily over time: 24% received DMARDs in 1996 compared with 43% in 2003 (P for trend P < 0.001). After the introduction of biologic DMARDs in 1998, 6% of all patients with RA received a biologic, including 12% who saw a rheumatologist. Patients ages 75–84 were 52% less likely to receive DMARDs (95% confidence interval [95% CI] 46–58%) and patients ages ≥85 were 74% less likely (95% CI 69–79%) compared with patients ages 65–74. Conclusion In this cohort of patients in the community with full prescription drug coverage, most patients diagnosed with RA did not receive a DMARD during the 12 months after cohort entry. Older patients and those not seeing a rheumatologist were less likely to receive a DMARD and may provide a target for quality improvement interventions.