Lee Jiha, Martindale Jonathan, Wallace Beth I, Singh Namrata, Makris Una E, Bynum Julie P W
University of Michigan, Ann Arbor.
University of Michigan, Ann Arbor, and VA Ann Arbor Healthcare System, Ann Arbor, Virginia.
ACR Open Rheumatol. 2025 Mar;7(3):e70013. doi: 10.1002/acr2.70013.
We evaluated changes in long-term glucocorticoid (GC) use and factors associated with persistent GC use in older adults with late-onset rheumatoid arthritis (LORA).
Using 20% Medicare data from 2008 to 2017, we identified adults ≥66 years with a new diagnosis of LORA, disease-modifying antirheumatic drug (DMARD) use or at least two rheumatologist visits, and at least 12 months of follow-up data. Older adults were categorized as DMARD-exposed or DMARD-unexposed based on treatment during the 12 months after LORA diagnosis (index date). For each quarter after the index date, long-term GC use was defined as having oral GC prescriptions for at least 30 days with a dose >5 mg/day prednisone equivalent. We compared long-term GC use between quarter (Q)1 and Q4 and performed stratified mixed-effects logistic regression for factors associated with persistent GC use, defined as long-term GC use in Q2 to Q4.
The cohort included 15,425 individuals with two-thirds (62.5%) being DMARD-exposed. Between Q1 and Q4, the proportion of older adults on long-term GC declined from 44.1 to 24.9% (∆19.2%) among the DMARD-exposed and from 25.8 to 17.9% (∆7.9%) among the DMARD-unexposed. One year after the index date, 13.5% of the DMARD-exposed and 9.8% of the DMARD-unexposed were persistent GC users. In stratified mixed-effects logistic models, persistent GC use was associated with low-income subsidy status among the DMARD-exposed and with greater comorbidity burden among DMARD-unexposed.
Long-term GC use declined more among DMARD-exposed than DMARD-unexposed patients. One in seven DMARD-exposed and one in ten DMARD-unexposed have persistent GC use which is associated with financial barriers and multimorbidity that may limit the use of steroid-sparing DMARDs.
我们评估了老年迟发性类风湿关节炎（LORA）患者长期使用糖皮质激素（GC）的变化情况以及与持续使用GC相关的因素。
利用2008年至2017年20%的医疗保险数据，我们确定了年龄≥66岁、新诊断为LORA、使用改善病情抗风湿药物（DMARD）或至少就诊过两次风湿病专科医生且有至少12个月随访数据的成年人。根据LORA诊断后（索引日期）12个月内的治疗情况，将老年人分为DMARD暴露组或DMARD未暴露组。在索引日期后的每个季度，长期使用GC定义为口服GC处方至少30天且剂量>5毫克/天泼尼松等效剂量。我们比较了第1季度和第4季度之间的长期GC使用情况，并对与持续使用GC相关的因素进行了分层混合效应逻辑回归分析，持续使用GC定义为第2季度至第4季度长期使用GC。
该队列包括15425名个体，其中三分之二（62.5%）为DMARD暴露组。在第1季度和第4季度之间，DMARD暴露组中使用长期GC的老年人比例从44.1%降至24.9%（下降19.2%），DMARD未暴露组中从25.8%降至17.9%（下降7.9%）。索引日期后一年，13.5%的DMARD暴露组和9.8%的DMARD未暴露组为持续使用GC者。在分层混合效应逻辑模型中，持续使用GC与DMARD暴露组的低收入补贴状态以及DMARD未暴露组的更高合并症负担相关。
DMARD暴露组的长期GC使用下降幅度大于DMARD未暴露组患者。七分之一的DMARD暴露组患者和十分之一的DMARD未暴露组患者持续使用GC，这与经济障碍和多种合并症有关，可能会限制使用能减少类固醇用量的DMARDs。
