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Too Few Get Needed Rheumatoid Arthritis Drugs: Study
Date:2/1/2011

By Steven Reinberg
HealthDay Reporter

TUESDAY, Feb. 1 (HealthDay News) -- Many people suffering from rheumatoid arthritis, many of them minority patients, aren't getting needed drug treatment, a new study finds.

Prescription drugs designed to slow progression of the deformities and disability related to rheumatoid arthritis should be used aggressively and early, expert guidelines say.

"Both patients and doctors need to be aware that patients with active rheumatoid arthritis need to be taking disease-modifying agents," said lead researcher Dr. Gabriela Schmajuk, an instructor in immunology and rheumatology at Stanford University School of Medicine.

"Patients need to be proactive about asking for these medications or asking to be referred to a provider that specializes in rheumatic diseases," she added.

Rheumatoid arthritis is an autoimmune disease, meaning the body is attacking its own tissues, which in turn causes swelling, pain and loss of function in the joints. Most of the 1.3 million Americans with the disease are women.

The report is published in the Feb. 2 issue of the Journal of the American Medical Association.

For the study, Schmajuk's team collected data from 2005 to 2008 on 93,143 Medicare patients with rheumatoid arthritis whose average age was 74.

Overall, about 63 percent of these patients were taking disease-modifying antirheumatic drugs, with the proportion rising to 67 percent by 2008, the researchers note. Schmajuk estimates that 90 percent of RA patients need these drugs.

"We found variations based on age, gender, race, geographic area, as well as health plan," Schmajuk said.

People 85 years and older were 30 percent less likely to receive the drugs than those 65 to 69 years old, Schmajuk's group found.

Blacks, men, the poor and patients living in low-income areas were also less likely to get antirheumatic medications, the researchers say. Geographically, residents of the Middle and South Atlantic states were least likely to get the drugs, while people in the Pacific region were most likely to get them.

People enrolled in for-profit health plans were less likely than those in not-for-profit plans to get the medications.

The medications, including Plaquenil (hydroxychloroquine), Cuprimine (penicillamine), Remicade (infliximab) and Azulfidine (sulfasalazine), can be used singularly or in combination, the researchers say.

A year's worth of the drugs can range in price from a few hundred dollars for older versions to thousands of dollars for some of the newer prescription medications, the researchers note.

"Since early and aggressive use of disease modifying agents are the main mechanism by which we can reduce morbidity in rheumatoid arthritis, as well as reduce costs, variations based on accidental factors such as these are unacceptable," Schmajuk said.

Commenting on the study, Dr. Ozlem Pala, an assistant professor of clinical medicine in the Division of Rheumatology & Immunology at the University of Miami Miller School of Medicine, said this study provides more evidence that some people don't have access to these important medications.

From Pala's viewpoint, cost is a barrier even though the patients in this study were receiving Medicare benefits. "The costs of these medications can be enormous," she said. "Some of the medications are not expensive, but some of the newer medications are very expensive," she added.

For Medicare patients the out-of-pocket co-payments can run to $4,000 a year, Pala said.

Another reason some patients may not be getting these drugs is that their doctor's don't prescribe them, Pala said. This is particularly true for primary care doctors.

"Patients should be referred to rheumatologists, because none of these medications are comfortably prescribed by primary care doctors, especially the newer agents. They are usually prescribed by rheumatologists," she said.

More information

For more information on rheumatoid arthritis, visit the U.S. National Library of Medicine.

SOURCES: Gabriela Schmajuk, M.D., instructor, immunology and rheumatology, Stanford University School of Medicine, Stanford, Calif.; Ozlem Pala, M.D., assistant professor of clinical medicine in the Division of Rheumatology & Immunology at the University of Miami Miller School of Medicine; Feb. 2, 2011, Journal of the American Medical Association


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