Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Section for Biostatistics and Evidence-Based Research, the Parker Institute, University of Copenhagen, Copenhagen, Denmark; Division of Rheumatology, University of California San Francisco, San Francisco, CA, USA.
Division of Rheumatology, University of California San Francisco, San Francisco, CA, USA.
Semin Arthritis Rheum. 2024 Oct;68:152535. doi: 10.1016/j.semarthrit.2024.152535. Epub 2024 Aug 22.
To assess relationships between the timing of glucocorticoid (GC) initiation, entrance into rheumatology care, and the duration of GC use in older adults with early rheumatoid arthritis (eRA) in the U.S.
Data from the Rheumatology Informatics System for Effectiveness (RISE) registry and Medicare (2016-2018) were linked. Patients with ≥2 RA ICD codes in RISE were included; the first being the index date which signaled entrance into rheumatology care. GC initiation (between 3 months before to 6 months after the index date) and continuous GC use up to 12 months after the index date were captured using Medicare claims. Cox proportional hazards models with adjustment for confounders assessed differences in the duration of GC use for patients initiating GCs before versus after the index date. Average daily GC doses were estimated.
1,733 patients (67 % female; mean age 76 ± 6 years) were included. 41 % initiated GCs, on average 16 ± 58 days before entering rheumatologic care. The mean duration of GC use was 157 days (95 %-CI 143 to 170). GC initiation before rheumatologic care was associated with longer GC use, even after adjustment for confounders (hazard ratio 0.61; 95 %-CI [0.51 to 0.74]). For patients using GCs for ≥3 months, average daily GC doses were <5 mg/d prednisone equivalent.
GCs are regularly used in eRA and most often initiated before patients enter rheumatology care. Long-term, low-dose GC use is common and associated with initiation before rheumatology care. Earlier referral to rheumatology might reduce GC exposure among U.S. patients with eRA.
评估美国老年早期类风湿关节炎（eRA）患者糖皮质激素（GC）起始时间、进入风湿病治疗时间和 GC 使用时间之间的关系。
对 Rheumatology Informatics System for Effectiveness（RISE）登记处和 Medicare 数据（2016-2018 年）进行了关联。RISE 中至少有 2 个 RA ICD 编码的患者被纳入研究；第一个是索引日期，表明进入风湿病治疗。使用 Medicare 理赔记录，在索引日期前 3 个月至后 6 个月内捕获 GC 起始（在索引日期之前和之后开始 GC 治疗的患者）和连续 12 个月内的 GC 使用情况。采用 Cox 比例风险模型，调整混杂因素后评估在索引日期之前和之后开始使用 GC 的患者 GC 使用时间的差异。估计平均每日 GC 剂量。
共纳入 1733 例患者（67%为女性；平均年龄 76±6 岁）。41%的患者开始使用 GC，平均在进入风湿病治疗前 16±58 天。GC 使用的平均持续时间为 157 天（95%CI 143-170）。即使在校正混杂因素后，在进入风湿病治疗前开始使用 GC 与 GC 使用时间更长相关（风险比 0.61；95%CI [0.51-0.74]）。对于使用 GC 治疗≥3 个月的患者，平均每日 GC 剂量<5mg/d 泼尼松等效剂量。
GC 在 eRA 中经常使用，并且通常在患者进入风湿病治疗之前开始使用。长期使用低剂量 GC 很常见，与在风湿病治疗前开始使用相关。在美国 eRA 患者中，早期转诊至风湿病科可能会减少 GC 暴露。
