Rheumatoid Arthritis Patients Not Getting Needed Medication


Effective, low-cost medication for relief of rheumatoid arthritis symptoms is available, yet many patients are not getting the treatment they need. Without proper medication, many people risk unnecessary suffering and deformity. The new study appears in the latest issue of JAMA.

Rheumatoid arthritis patients need early treatment

Early, aggressive treatment is the recommended approach for rheumatoid arthritis, yet only 63 percent of patients under Medicare were prescribed the drugs they need, according to a Stanford University School of Medicine study. Those medications are DMARDs, or disease-modifying antirheumatic drugs.

Gabriela Schmajuk, MD, lead author of the study and a postdoctoral scholar in the Division of Immunology and Rheumatology, noted that “closer to 90 percent should be receiving treatment.” While some of the newer DMARDs can cost thousands of dollars per year, older versions are much less costly.

Although there are many ways to treat the symptoms of rheumatoid arthritis besides DMARDs, including anti-inflammatory drugs, biologics, steroids, acupuncture, exercise therapy, dietary therapy, and herbal remedies, medical guidelines recommend use of DMARDs, which can help ward off or reduce the crippling results of the disease.


The investigators evaluated variations in medication treatment of 93,143 patients who had rheumatoid arthritis who were 65 years or older. Data for the analysis came from the Centers for Medicare and Medicaid HEDIS database. The database contains about 300 healthcare plans from across the nation.

The number of patients who received needed medication ranged widely depending on the area of the country, income level, race, and which health care plan individuals had. For example, low-income individuals were less likely to receive needed prescriptions than wealthier patients, and blacks were less likely than whites to get the prescriptions.
The researchers also found that “patients who lived in the mid- and south-Atlantic regions received medications less frequently than other areas, particularly the West Coast states,” according to Schmajuk.

Despite adjustments for age, race, income, and location, the investigators also found a vast difference in which patients received prescriptions based on the healthcare plan. While some plans treated more than 80 percent of their patients with appropriate medications, others provided adequate care to less than 20 percent.

Left untreated, one-third of rheumatoid arthritis patients become disabled within five years of their diagnosis, leaving individuals unable to use their hands for everyday activities or work, and in many cases, unable to care adequately for themselves. In addition, people with severe rheumatoid arthritis are more prone to infection.

Schmajuk noted that even though their study “counted patients who received the bare minimum amount of treatment,” they still found “a large proportion of patients aren’t getting the medication they need.” Individuals who want more information about rheumatoid arthritis can visit the Centers for Disease Control and Prevention website, the National Arthritis Foundation, and the Arthritis Foundation.

Stanford University School of Medicine