Gastrointestinal prophylactic therapy among patients with arthritis treated by rheumatology specialists

Elizabeth Benito Garcia, Kaleb Michaud, Frederick Wolfe

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective. To determine rates of gastroprotective agent (GPA) use among patients with arthritis treated by rheumatologists, and to determine factors associated with GPA prescription. Methods. In a longitudinal outcome study, 11,451 patients with rheumatoid arthritis (RA) and osteoarthritis (OA) reported all medication use, ulcer history, functional status, and sociodemographic characteristics. Results. GPA were used in 21-24% of all patients with RA and OA and in about 35-40% of all high risk patients. In unadjusted analyses, GPA use was similar among NSAID users and non-users. In multivariable logistic regression analyses GPA use was associated with non-specific (NS) NSAID and COX-2 NSAID, prednisone, low dose aspirin, comorbidity, Health Assessment Questionnaire functional score, age < 65 years, increased income, not smoking, and being male. Despite numerous associations, the explanatory power for GPA use was poor (area under ROC curve = 0.680). Conclusion. GPA are used in 35% to 40% of patients with 4 risk factors for gastrointestinal ulceration. GPA use is not increased in NS NSAID users compared to COX-2 NSAID users, and was inversely associated with socioeconomic status. GPA use does not follow the model predicted by clinical trial results with respect to NS NSAID and age, reflecting a change in the pattern of NSAID use in patients with rheumatic disease. The major determinant of GPA use appears to be physician prescribing behavior.

Original languageEnglish (US)
Pages (from-to)779-784
Number of pages6
JournalJournal of Rheumatology
Volume33
Issue number4
StatePublished - Apr 1 2006

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Rheumatology
Non-Steroidal Anti-Inflammatory Agents
Arthritis
Osteoarthritis
Therapeutics
Rheumatoid Arthritis
Prednisone
Rheumatic Diseases
Social Class
ROC Curve
Aspirin
Ulcer
Area Under Curve
Prescriptions
Longitudinal Studies
Comorbidity
Logistic Models
Smoking
Regression Analysis
Outcome Assessment (Health Care)

Keywords

  • Arthritis
  • Gastroprotective agents
  • Proton pump inhibitors
  • Ulcer

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

Cite this

Gastrointestinal prophylactic therapy among patients with arthritis treated by rheumatology specialists. / Garcia, Elizabeth Benito; Michaud, Kaleb; Wolfe, Frederick.

In: Journal of Rheumatology, Vol. 33, No. 4, 01.04.2006, p. 779-784.

Research output: Contribution to journalArticle

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abstract = "Objective. To determine rates of gastroprotective agent (GPA) use among patients with arthritis treated by rheumatologists, and to determine factors associated with GPA prescription. Methods. In a longitudinal outcome study, 11,451 patients with rheumatoid arthritis (RA) and osteoarthritis (OA) reported all medication use, ulcer history, functional status, and sociodemographic characteristics. Results. GPA were used in 21-24{\%} of all patients with RA and OA and in about 35-40{\%} of all high risk patients. In unadjusted analyses, GPA use was similar among NSAID users and non-users. In multivariable logistic regression analyses GPA use was associated with non-specific (NS) NSAID and COX-2 NSAID, prednisone, low dose aspirin, comorbidity, Health Assessment Questionnaire functional score, age < 65 years, increased income, not smoking, and being male. Despite numerous associations, the explanatory power for GPA use was poor (area under ROC curve = 0.680). Conclusion. GPA are used in 35{\%} to 40{\%} of patients with 4 risk factors for gastrointestinal ulceration. GPA use is not increased in NS NSAID users compared to COX-2 NSAID users, and was inversely associated with socioeconomic status. GPA use does not follow the model predicted by clinical trial results with respect to NS NSAID and age, reflecting a change in the pattern of NSAID use in patients with rheumatic disease. The major determinant of GPA use appears to be physician prescribing behavior.",
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