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. 2012 Feb;64(2):184-9.
doi: 10.1002/acr.20674.

Use of disease-modifying medications for rheumatoid arthritis by race and ethnicity in the National Ambulatory Medical Care Survey

Daniel H Solomon  1 , John Z Ayanian, Ed Yelin, Tamara Shaykevich, M Alan Brookhart, Jeffrey N Katz
Affiliations

Use of disease-modifying medications for rheumatoid arthritis by race and ethnicity in the National Ambulatory Medical Care Survey

Daniel H Solomon et al. Arthritis Care Res (Hoboken). 2012 Feb.

Abstract

Objective: Disease-modifying antirheumatic drugs (DMARDs) are recommended for virtually all patients with rheumatoid arthritis (RA). We investigated the use of DMARDs in patients with RA in a nationally representative sample of visits to US physicians in the National Ambulatory Care Medical Survey (NAMCS).

Methods: We analyzed the NAMCS visit data from 1996 through 2007 if the physician noted a diagnosis of RA. DMARD utilization was based on the medications listed by the physician. We used generalized linear models to examine the adjusted associations between DMARD use and potential predictors.

Results: Of the 859 visits with a diagnosis code of RA identified over the study period, 404 visits (47%; 95% confidence interval [95% CI] 44-50%) had an associated DMARD. The percentage of RA visits with DMARDs increased slightly over the 12 years (P = 0.048), with biologic DMARDs increasing to 20% of visits after their introduction (P for trend <0.001). In fully adjusted models, African American race was associated with a 30% reduction in DMARD prescribing (risk ratio [RR] 0.70, 95% CI 0.48-1.00). A visit to a rheumatologist was the strongest correlate of DMARD prescribing (RR 2.33, 95% CI 1.89-2.86). Among visits to nonrheumatologists, African Americans were significantly less likely than whites to receive a DMARD (RR 0.39, 95% CI 0.17-0.92), but not among visits with rheumatologists (RR 0.81, 95% CI 0.52-1.27).

Conclusion: In the NAMCS, most visits coded with RA did not have an associated DMARD prescription. African Americans were less likely to receive DMARDs than whites, particularly when visiting nonrheumatologists.

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Figures

Figure 1
Figure 1
The figure shows the percent of NAMCS visits with rheumatoid arthritis noted where a DMARD was listed. Data are graphed in three-year blocks across the 12 year study period, and are shown separately for any DMARD (black circles), non-biologic DMARDs (grey circles), and biologic DMARDs (white circles). There is only a black circle at the first time period (1996-1998) because all DMARDs were non-biologic. Over the period studied, there was a slight increase in any DMARD use (p for trend = 0.048), while there was an increase in biologic DMARD use (p for trend < 0.001).
Figure 2
Figure 2
The figure shows the percent of NAMCS visits with rheumatoid arthritis noted where a non-DMARD medication (oral glucocorticoid, opioid, or NSAID) was listed. Data are graphed across the 12 year study period in three-year blocks, and are shown separately for oral glucocorticoids (black circle), opioids (grey circle) and NSAIDs/coxibs (white circle).
See this image and copyright information in PMC

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