Scientists from Michigan Medicine found that despite guidelines that call for early and aggressive treatment of rheumatoid arthritis, many older adults are not prescribed disease-modifying medications for their inflammatory autoimmune disease.
The research is published in ACR Open Rheumatology and was conducted by Jiha Lee et al.
In the study, the team analyzed all ambulatory visits for rheumatoid arthritis by adults 65 years of age and older, representing 7.8 million visits from 2005 to 2016.
They found that only 45% of patients were prescribed disease-modifying antirheumatic drugs, like methotrexate, which are used to treat inflammation caused by several diseases.
The team ssays these medications have really changed the landscape of rheumatology, allowing low disease activity and remission to be achieved in people with rheumatoid arthritis.
Now there needs to be a shifting consideration of how we can better target their use among older adults
The prescription rates for these disease-modifying drugs have improved over the past few decades, but there is more work to be done to ensure older adults are on optimized treatment.
One in four patients observed in the study visited primary care physicians for their rheumatoid arthritis, while the others were seen by rheumatologists.
Those physicians prescribed disease-modifying antirheumatic medications in 30% of visits, compared to 56% by rheumatologists.
Data from the 1990s and early 2000s estimate these drugs were prescribed to fewer than 30% of older adults with rheumatoid arthritis.
The team says the rise in prescriptions likely reflects a shift towards early treatment and expanded Medicare coverage.
Despite this recent increase, Lee says, prescription practices of both rheumatologists and primary care physicians fall below the standard.
The team says prescribing for older adults is challenging because polypharmacy and multimorbidity are common, and this population is more prone to the negative effects of disease-modifying drugs.
However, doctors should be cautious that older adults do not experience more pain and deformities that really limit their functioning because of undertreatment.
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