Left Out of Latest RA Treatments

Rheumatoid arthritis patients who are poorer or older may lack access to newer treatments

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Over the past decade, advances in the treatment of rheumatoid arthritis have made it easier for patients to live with this painful condition. Unfortunately, some patients may not have access to the newest treatments.

Researchers found that patients with rheumatoid arthritis who are poor or lack access to an arthritis specialist may not be getting the latest drug treatments, which have been shown to be better at controlling symptoms.

These findings suggest that many Medicare and Medicaid patients are not receiving DMARDs, a type of drug they would likely benefit from.

"Ask your doctor about all arthritis treatment options."

"Our study shows that critical rheumatoid arthritis therapies are not reaching everyone. Older and poorer patients are particularly vulnerable, and patients who do not see a rheumatologist are the least likely to receive appropriate treatment for rheumatoid arthritis," said Jinoos Yazdany, MD, MPH, of the University of California, San Francisco.

"The study highlights the urgent need to facilitate and improve access to rheumatologists," she said.

A number of studies have suggested that treating patients with disease-modifying antirheumatic drugs (DMARDs) is effective at controlling the progression of rheumatoid arthritis. However, other studies have shown that only 60 percent of Medicare patients receive DMARDs, which are prescribed by rheumatologists.

Dr. Yazdany and colleagues found that older and poorer Medicare patients were more likely to receive steroids as the only treatment for rheumatoid arthritis.

A total of 18 percent of 85-year-old patients received steroids as their only arthritis treatment, while 11 percent of 74- to 79-year-olds received only steroids.

Compared to the 10 percent of higher income patients who only received steroids, 12 percent of low-income patients received steroids as their only treatment.

When a rheumatologist prescribed one or more drugs, there were much lower rates of patients who only received steroids.

Steroid-only use was associated with higher inpatient admissions like hospital visits.

"Our findings strongly suggest that even minimal contact with a rheumatologist, i.e., one visit per year, significantly impacts the use of DMARD therapy in patients with active rheumatoid arthritis," said Dr. Yazdany.

The study included 8,062 participants who were enrolled in Medicare Part D and received either DMARDs or steroids. Of these, 10 percent received only steroids to treat their rheumatoid arthritis.

The research was funded by the National Institute of Health, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, University of California, San Francisco Resource Allocation Program and University of California, San Francisco Rosalind Russell Center for Arthritis.

The study was presented at the American College of Rheumatology's Annual Meeting. As such, the research has yet to be peer-reviewed for publication in a scientific journal.

Reviewed by: 
Review Date: 
November 14, 2012
Last Updated:
May 17, 2013