Dr. Solomon has received research grants from Amgen, Abbott, and Lilly, conducted an educational course sponsored by Bristol-Myers Squibb, has had unpaid positions on two Pfizer-sponsored trials (neither involving disease-modifying antirheumatic drugs), and is a consultant to CORRONA regarding epidemiology.
Use of disease-modifying medications for rheumatoid arthritis by race and ethnicity in the National Ambulatory Medical Care Survey
Version of Record online: 25 JAN 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis Care & Research
Volume 64, Issue 2, pages 184–189, February 2012
How to Cite
Solomon, D. H., Ayanian, J. Z., Yelin, E., Shaykevich, T., Brookhart, M. A. and Katz, J. N. (2012), Use of disease-modifying medications for rheumatoid arthritis by race and ethnicity in the National Ambulatory Medical Care Survey. Arthritis Care Res, 64: 184–189. doi: 10.1002/acr.20674
- Issue online: 25 JAN 2012
- Version of Record online: 25 JAN 2012
- Accepted manuscript online: 19 OCT 2011 08:59AM EST
- Manuscript Accepted: 11 OCT 2011
- Manuscript Received: 16 MAY 2011
- NIH. Grant Numbers: R01-AR056215, P60-AR47782
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).
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.
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).
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.