By Rita Baron-Faust, MPH

Even with health insurance, some patients with rheumatoid arthritis (RA) may not be adequately treated. This news comes from an analysis of a large nationwide pharmaceutical claims database.

Analysis of claims data from 4.66 million American adults treated for RA between January 2005 and September 2008, finds that only two-thirds of patients with newly diagnosed disease received DMARD therapy during the first year after their diagnosis.

And 28% received no DMARDs at all, just treatment for symptoms.

Those patients receiving only symptomatic relief tended to be older and had more co-morbidities and contraindications to methotrexate, according to the industry-sponsored retrospective cohort study.

At the same time, the authors observe, “this population was arguably underserved because 38% of this inception cohort did not see a rheumatologist in year one, and 15% never saw one over a median of 2.3 years of follow-up.”

Although one-fifth did receive biologics within 12 months, there was extensive medication switching among the group, and a relatively rapid decline over time in patients who stayed on the drugs.

The analysis reveals a somewhat lower incidence of RA than other population studies, but a similar age and gender adjusted prevalence of RA (0.63% overall, and 0.33% in men and 0.92% in women).

While the data lack supporting clinical information, such administrative databases can reflect actual treatment patterns in daily clinical practice. The same patterns of treatment of RA have been seen in other studies, they note.

The study was aimed at determining whether physicians were following current American College of Rheumatology RA treatment guidelines.

There could be a number of reasons for the apparent under-treatment of patients, the study authors speculate: lack of physician awareness of, or disagreement with, treatment guidelines; and determinations that patients were too old, their disease too mild, or there were contraindications for therapy.

Patients may have also wanted to avoid drug treatment due to adverse effects or costs, they add.

Within 12 months after their diagnosis, 65%, 64%, and 20% of the incident cohort (those without an apparent prior diagnosis of arthritis) had been prescribed corticosteroids, non-biologic DMARDs, and TNF-inhibitors, respectively.