Male sex, older age, lower socioeconomic status, higher comorbidity score, and having an older or male rheumatologist were associated with the reduced likelihood of continuing with rheumatoid arthritis (RA) treatment.
Patients with rheumatoid arthritis (RA) were less likely to continue with treatment if they were male, older in age, of lower socioeconomic status, or had a higher comorbidity score or an older rheumatologist, according to a study published in ACR Open Rheumatology.
To come to this finding, the study authors identified 50,883 adult patients with RA from Ontario, Canada who received a RA diagnosis between 2002 and 2014.
All patients were aged 18 or older at the time of diagnosis, and 26.1% were aged 66 or older at that time. Most (70.8%) participants were female, and the mean (SD) age was 55.4 (14.8) years.
The authors found that, while all patients had 5 or more years of potential follow-up prior to 2019, more than half (57.7%) saw a rheumatologist every year in all 5 years of follow-up and 77.4% had a follow-up visit for at least 3 of the 5 years.
The authors also noted sharp declines in the proportion of patients receiving annual care year after year. However, for those who saw a rheumatologist all 5 years, there was a linear trend of improved retention.
Retention also varied by the year of diagnosis, with only 63% of those who received a RA diagnosis in 2002 receiving consistent care by year 5, compared with 70.3% of those who received a diagnosis in 2013. In general, 82.2% of patients received care in year 2 and 66.1% received care in year 5.
Regarding sex, male patients with RA were less likely to receive continuous care compared with female patients.
“The reasons for this are unknown but are likely complex; they could relate to gender roles or possibly to disease activity and/or disease impact (which were not captured in our study), as these may be lower in male populations,” the authors explained. “In Canada, there are gender differences in health-seeking behaviours in the general population, with women more likely to seek care than men for both physical and mental health concerns.”
They also found that patients with male rheumatologists had lower odds of receiving consistent care compared with patients with female rheumatologists, and that having an older rheumatologist was associated with lower odds of continuous care, though these findings warrant further research.
“This may be because older physicians may be transitioning to retirement and discharging patients who are more stable to primary care or potentially limiting follow-up visits,” the authors said. “It is also possible that older rheumatologists may have different practice patterns for care that may be less concordant with current treat-to-target guidelines that endorse more frequent follow-ups.”
Similar to the overall negative trend of treatment continuation over time, individuals aged 66 and older with RA were less likely to continue with RA care for all 5 years, and therefore less likely to receive a disease-modifying antirheumatic drug (DMARD). Among older patients, 82.1% who saw a rheumatologist annually received a DMARD by year 5, while only 31% of patients who received inconsistent care received it within that time frame.
Past Canadian studies have demonstrated a relationship between low socioeconomic status and higher disease activity, and some US studies have suggested that the lack of DMARD receipt was linked to lower socioeconomic status.
In this study, low socioeconomic status was linked to decreased odds of consistent care, and the authors noted that regional strategies may be necessary to provide underserved and rural communities with adequate RA care.
In another statistically insignificant finding, higher comorbidity score was linked to lower odds of continuous RA follow-up.
“Future research efforts need to investigate the causes of these challenges to continuously accessing care as well as the degree to which patient outcomes are impacted,” the authors concluded. “This research will contribute to strategies to inform health system design in order to better address patient needs, improve patient access to ongoing care, and improve health equity.”
Barber CEH, Lacaille D, Croxford R, et al. A population-based study evaluating retention in rheumatology care among patients with rheumatoid arthritis. ACR Open Rheumatol. Published online May 5, 2022. doi:10.1002/acr2.11442