Missed opportunities for treatment of inflammatory arthritis and factors associated with non-treatment: An observational cohort study in United States Veterans with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis.

Abstract

OBJECTIVE:

To identify factors associated with non-treatment with biologic and non-biologic disease modifying anti-rheumatic drugs (DMARDs) during the 12 months after initial inflammatory arthritis (IA) diagnosis.

METHODS:

We identified Veterans with incident IA diagnosed in 2007-2019. We assessed time to treatment with Kaplan-Meier curves. We identified associations between non-treatment and factors relating to patients, providers, and the health system with multivariate Generalized Estimation Equation (GEE) log-Poisson. Subgroup analyses included IA subtypes (rheumatoid arthritis [RA], psoriatic arthritis [PsA], and ankylosing spondylitis [AS]) and timeframes of the initial IA diagnosis (2007-11, 2012-15, and 2016-19).

RESULTS:

Of 18,318 study patients, 40.7 % did not receive treatment within 12 months after diagnosis. In all patients, factors associated with non-treatment included Black race (hazard ratio, 95 % confidence interval: 1.13, 1.08-1.19), Hispanic ethnicity (1.14, 1.07-1.22), Charlson Comorbidity Index ≥2, (1.15, 1.11-1.20), and opiate use (1.09, 1.05-1.13). Factors associated with higher frequency of DMARD treatment included married status (0.86, 0.81-0.91); erosion in joint imaging report (HR: 0.86, 0.81-0.91); female diagnosing provider (0.90, CI: 0.85-0.96), gender concordance between patient and provider (0.91, CI: 0.86-0.97), and diagnosing provider specialty of rheumatology (0.53, CI: 0.49-0.56).

CONCLUSION:

A high proportion of Veterans with IA were not treated with a biologic or non-biologic DMARD within one year after their initial diagnosis. A wide range of factors were associated with non-treatment of IA that may represent missed opportunities for improving the quality of care through early initiation of DMARDs.

• Authors: Jessica A Walsh, Shaobo Pei, Swetha Alexander, Tawnie Braaten, Jodi H Walker, Jerry Clewell, Kevin M Douglas, Gopi K Penmetsa, Xiangyang Ye, Brian Breviu, Grant W Cannon, Gary A Kunkel, Brian C Sauer
• Journal: Seminars in arthritis and rheumatism (Semin Arthritis Rheum) Vol. 66 Pg. 152436 (Jun 2024) ISSN: 1532-866X [Electronic] United States
• PMID: 38714073 (Publication Type: Journal Article, Observational Study, Research Support, U.S. Gov't, Non-P.H.S., Research Support, Non-U.S. Gov't, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2024. Published by Elsevier Inc.

Chemical References

• Antirheumatic Agents

Topics

• Humans
• Male
• Female
• Spondylitis, Ankylosing (drug therapy)
• Arthritis, Rheumatoid (drug therapy)
• Arthritis, Psoriatic (drug therapy, diagnosis)
• Antirheumatic Agents (therapeutic use)
• Middle Aged
• Veterans (statistics & numerical data)
• United States
• Aged
• Cohort Studies
• Adult
• Time-to-Treatment (statistics & numerical data)