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Laura J. Martin, MD
Feb. 1, 2011 -- Widely available drugs that are recommended early in the treatment of rheumatoid arthritis are not being prescribed nearly as much as they could be.
That’s the conclusion of a new study that says effective medicines called disease-modifying antirheumatic drugs (DMARDs) are not being used as aggressively as called for under accepted medical guidelines.
Researchers say that only 63% of Medicare patients reviewed for the study received any amount of the prescription medications.
“Among patients with a true diagnosis of rheumatoid arthritis, closer to 90% should be receiving treatment,” study researcher Gabriela Schmajuk, MD, a postdoctoral scholar at Stanford, says in a news release.
Schmajuk and colleagues, including Jinoos Yazdany, MD, MPH, of the University of California, San Francisco, report that the number of patients receiving the effective medications varies dramatically by health care plan, economic status, and where the patients live.
Rheumatoid arthritis is a chronic, painful disease that leads to inflammation of the joints and tissues around the joints. RA is considered an autoimmune disease.
The disease, which usually strikes people between the ages of 40 and 60, afflicts 1.3 million Americans, is three times more common in women than men.
“The reason [DMARD] treatment is so important is that, if left untreated, one-third of the patients with rheumatoid arthritis will become disabled within five years of diagnosis,” Schmajuk says. “The disease primarily affects the hands. Frequently patients are unable to work because they can’t use their hands.”
The large study examined differences in medication treatment of 93,143 people with rheumatoid arthritis ages 65 and older between the years 2005 and 2008. Information was obtained from the Healthcare Effectiveness Data and Information Set, also known as HEDIS.
HEDIS, in 2005, introduced a quality measure to assess the number of RA patients receiving DMARDs.
“We found that certain groups were not receiving the medication they needed,” Schmajuk says. “Patients who had low income received DMARDs less frequently than wealthier patients. Blacks received medications less frequently than whites. We also found that patients who lived in the mid-and south-Atlantic regions received medications less frequently than other areas, particularly the West Coast states.”
Treatment varied dramatically among health care plans, according to the researchers.
“Some plans were doing really well, with over 80% of patients being treated appropriately,” Schmajuk says. “Other plans had fewer than 20% of patients getting appropriate care, which is really worrisome. We know this wasn’t because of the individual characteristics of the patients since the health plan results were adjusted for age, race, income, and geographic region.”
The researchers did not investigate the causes of variations in treatment but speculate the some health plans may have different policies about when patients can see certain types of specialists.
Or Schmajuk says, “one health care plan might have one rheumatologist for 5,000 patients versus another that provides one for every 500 patients.”
In some cases there may be medical reasons why RA patients are not taking DMARDs, such as possible interactions of the medications with other drugs. Also, the study suggests co-payments for DMARDs may have an impact on the number of people being prescribed the drugs.
“Given the enormous individual and societal costs associated with RA, and increasing substantial evidence that DMARDs can reduce these costs, variations in DMARD receipt based on demographics, socioeconomic status and geography are unacceptable,” the researchers write. “Because optimizing DMARD use is the primary mechanism for decreasing the significant public health impact of RA in the United States, targeting educational and quality improvement interventions to patients who are under using DMARDs and their clinicians will be important to eliminate these disparities.”
The researchers say people with RA and their health care providers need to be more aware of the benefits of DMARDs.
The study is published in the Feb. 2 issue of the Journal of the American Medical Association.
SOURCES:News release, Stanford University.News release, Journal of the American Medical Association.Schmajuk, G. Journal of the American Medical Association, Feb. 2, 2011; vol 305: pp 480-486.
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