Abstract
IntroductionDisease-modifying antirheumatic drugs (DMARDs) have become the treatment standard for patients with rheumatoid arthritis (RA). Although several general-population studies document that a large population of patients diagnosed with RA do not use DMARDs, little is known about this group. We explored the characteristics, experiences, and knowledge of a low-income, elderly RA population not currently using DMARDs, or receiving care from a rheumatologist.MethodsWe administered structured telephone interviews to participants enrolled in a large pharmacy benefits program for the elderly who had two diagnoses of RA ≥7 days apart and no DMARD prescriptions or rheumatologist visits in the prior year. The interview contained questions concerning each participant’s sociodemographic information, disease activity, DMARD experiences, and the Modified Health Assessment Questionnaire (MHAQ). We described responses and compared prior users with never users.ResultsA total of 86 people completed the interview. The mean age was 80 years and 89% were female. On average, disease duration was 20 years. Mean MHAQ score was 0.55 (SD = 0.55). Of 86 participants, 19 had previously used DMARDs, 10 of whom discontinued them because of side effects or safety concerns. Among 67 never-users, 35 (52.2%) reported that their physicians had never offered them DMARDs, 13 (19.4%) described fear of side effects, and 49 (73.1%) knew nothing about them. Prior-users reported experiencing more-severe RA symptoms than never-users.ConclusionsWe found that side effects or safety concerns were the primary cause for DMARD cessation among prior-users. Among never-users, most reported never discussing or being offered DMARDs, suggesting that an educational gap may deter patients with RA from using them.
Highlights
Disease-modifying antirheumatic drugs (DMARDs) have become the treatment standard for patients with rheumatoid arthritis (RA)
The Pharmaceutical Assistance Contract for the Elderly (PACE) program supplied us with the contact information of individuals that had received a minimum of two RA diagnoses and had no prescription for DMARDs in the prior year
We studied a cohort of older RA patients who had not filled prescriptions or received infusions for DMARDs in the prior year
Summary
Disease-modifying antirheumatic drugs (DMARDs) have become the treatment standard for patients with rheumatoid arthritis (RA). Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disorder that increases the risk of disability and early mortality [1]. Disease-modifying antirheumatic drugs (DMARDs) have been recommended as the standard of care because of their consistent reduction of pain and disability in patients that have lived RA for several decades [7]. Studies demonstrate that delays in the implementation of DMARD treatment have been associated with increased physical disability, radiologic damage, and other long-term health outcomes [8,9]. The American College of Rheumatology (ACR) and European League Against Rheumatism both recommend early and aggressive DMARD treatment to essentially all patients with RA [10,11]
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