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Adults with RA Undermedicated

Older adults with rheumatoid arthritis still undermedicated, despite aggressive guidelines” by Michigan Medicine asserts that RA patients treated by primary care physicians were prescribed disease-modifying antirheumatic medications in 30% of visits, compared to 56% by rheumatologists.

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Despite guidelines that call for early and aggressive treatment of rheumatoid arthritis, a new study suggests many older adults are not prescribed disease-modifying medications for their inflammatory autoimmune disease.

Researchers at Michigan Medicine used the National Ambulatory Medical Care Survey to analyze 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 results are published in ACR Open Rheumatology.

About one-fifth of patients not prescribed disease-modifying antirheumatic drugs took only steroids for their rheumatoid arthritis, which can cause pain and stiffness in the joints. Rheumatologists generally advise against the use of steroids, which can increase the possibility of gastric ulcer, poor glycemic control, and osteoporosis and subsequent fracture.

Disease-modifying antirheumatic drugs also come with potential disadvantages — they’re immunomodulatory or immunosuppressant medications; as they combat inflammation caused by the disease, they stifle the immune system and increase the risk of serious infections.


With an aging world population, rheumatologists have an important opportunity to work yet more closely with primary care providers to improve prescribing practices.