Population Variations in Rheumatoid Arthritis Treatment and Outcomes, Northern California, 1998–2009

Abstract

Objective: To assess variations in rheumatoid arthritis treatment and outcomes at the community level from 1998 through 2009. Methods:The study used computerized data from 16 Kaiser Permanente Northern California Medical Centers. Mixed modeling was used to assess patterns across time and clinic. The analysis accounted for patient demographics, clustering of patients within Medical Centers, and repeated measures of patients over time. The metric used to measure drug use, months of use per patient per year, included both users and nonusers in the denominator, to account for both prevalence and duration of use.Results: Assessment was performed of 28,601 patients with rheumatoid arthritis, with all levels of severity. From 1998 through 2009, methotrexate use doubled in the typical patient to include 23% of the time they were observed; sulfasalazine and hydrochloroquine use declined. By 2008 through 2009, leflunomide and antitumor necrosis factor agents were used by the typical patient 4% and 9% of the time, respectively. Between 1998 and 2009, disease-modifying antirheumatic drug use increased in the typical patient from 38% to 63% of the time, and oral prednisone use declined from 23% to 15% of the time, whereas opioid use initially rose but then fell to 23% of the time. No variations over time were observed for the rate of hospitalized pneumonia or opportunistic infection. Variation across clinics, measured by the difference in drug use between clinics at the 75th and 25th percentiles, was lowest for opioids (25% vs 20% of the time) and greatest for infliximab (< 1% to 3%).Conclusion: Increased use of disease-modifying antirheumatic drugs and declines in prednisone are encouraging. Opioid use may need intervention.

Trends in diagnostic prevalence and treatment patterns of male and female ankylosing spondylitis patients in the United States, 2006–2016

“…When analyzing 1996–2009 computerized health care data from Kaiser Permanente Northern California, Curtis and colleagues reported a point prevalence of AS standardized to the 2000 US census of 2.26 per 1000 (~ 0.23%) [8]. These findings were higher than the rates reported during our study, but lower than previously reported prevalence rates in the U.S. For example, based on the 2009–2010 NHANES data, axSpA (AS and nr-axSpA) prevalence was approximately 1.4% in the U.S. [7].…”

“…Since our study analyzed the diagnostic prevalence of AS patients by identifying patients with ICD-9 and/or ICD-10 codes, our findings could be an under-representation of the overall AS population. As reported by Curtis et al, using different case definitions based on the same ICD codes may lead to variation in the prevalence estimates [8]. Published reports have indicated a delay in diagnosis of up to 10 years for AS patients [18, 19].…”

Retrospective Analysis of the Impact of Adalimumab Initiation on Corticosteroid Utilization and Medical Costs Among Biologic-Naïve Patients with Rheumatoid Arthritis

“…Additionally, Chu et al noted that ADA nonadherence among adult RA patients was associated with corticosteroid use [29]. In examining RA treatment trends, Herrinton et al noted that as use of DMARDs including biologics increased (from 38 to 63%) between 1998 and 2009, use of steroids decreased (from 23% to 15%) [30]. The cumulative findings of these studies suggest that implementation of medication therapy considered more effective in the treatment of RA, namely biologic DMARDs, is associated with reduced need for less effective co-therapies such as steroids.…”

Tendon Transfers in the Rheumatoid Hand for Reconstruction

“…The increased use of disease-modifying antirheumatic drugs (DMARDs) and the introduction of biologic DMARDs have resulted in a greater proportion of patients experiencing remission or lower disease activity status. 2,3 The increasing use of these agents has resulted in lower rates of progression of radiographic disease in a prospective observational study following patients for 10 years. 2 At present, it is not known whether the improvements in medical management of this disease can influence the rates of tendon rupture.…”