If you are over the age of 65 and have rheumatoid arthritis (RA), your physician may not be treating you as aggressively as recommended by American College of Rheumatology (ACR). Updated in 2021, the guidelines endorse early treatment with DMARDs (disease-modifying antirheumatic drugs), medications that help decrease pain and prevent joint damage. However, a study published in ACR Open Rheumatology in January 2022, conducted by researchers at University of Michigan (UofM) Medicine, found that older people were receiving this treatment in far fewer numbers than younger people who had RA.
Rheumatoid arthritis is a progressive disease; early, aggressive treatment can reduce symptoms such as fatigue and prevent irreversible joint damage.
The research team used the National Ambulatory Medical Care survey to analyze almost eight million ambulatory visits by patients aged 65 and older from 2005 to 2016 for RA, an inflammatory autoimmune disease that affects more than one million Americans. We discovered that while the guidelines recommend that everybody with the RA diagnosis should be on some form of treatment, less than half of older adults are on any form of treatment, which is lower than what we expect. In the younger population, that number is closer to 80 percent. There is undertreatment overall with the DMARDs. Even among those, the biologics are the newer medications that have significantly changed the outcomes with rheumatoid arthritis, and that are prescribed in fewer proportions in older adults, says Jiha Lee, MD, MHS, a rheumatologist at UofM Health and lead author of the study.
It concluded, DMARD use for older adults with RA remains low from both rheumatologists and PCPs [primary care physicians], including biologic DMARDs, even though American College of Rheumatology guidelines recommend earlier and more aggressive treatment of RA.
Also of interest is that 74 percent of the visits were with rheumatologists; the rest were with primary care physicians PCPs. The study found that any DMARD use was recorded at 56 percent of rheumatologist and 30 percent of PCP visits. Among visits with any DMARD use, 20 percent of rheumatologist visits had two or more DMARDs compared with 6 percent of PCP visits.
If the disease is less than treated, there's a slew of consequences that can happen with that. The most obvious ones are decreasing quality of life, increase in depression rate, increase in pain. I think it's really one of the things that we should pay attention to, says Vinicius Domingues, MD, rheumatologist from Daytona Beach, Florida, and medical advisor to CreakyJoints.
Dr. Lee theorizes that the difference in prescribing can be due to several factors, one of which is ageism. She points to research published in Rheumatology, where rheumatologists were presented with the same clinical scenario of an RA patient, only changing the ages. When the same disease script was for an older patient, the rheumatologists were less likely to suggest aggressive treatment. There may be hesitancy on the patient side but there also may be the same hesitancy on the physician side, she says.
Other concerns are:
There are a lot of other factors that play into this that have yet to be further understood. But that doesn't mean that older patients should be receiving less aggressive treatment if there are better outcomes to be achieved, says Lee.
Dr. Domingues agrees, The risk of side effects increases as you get older, so physicians often want to protect these patients, but actually, you're doing a disservice to them if you don't treat the disease.
Doctors need to get patient-informed consent. Outline to the patient the benefits and possible risks. If the answer is yes, you move forward. If the answer is no, you try to find an alternative medication that has less side-effect profile. And if nothing is achieved, then again, it's the patient decision at the end of the day, but you have to include them into the conversation, explains Domingues.
As noted earlier, PCPs tend to underprescribe for RA significantly more than rheumatologists. Lee urges seeing a rheumatologist over a PCP, if you can. Seeing your primary care doctor can help achieve early diagnosis but they're not the ones who should be responsible for prescribing the DMARDS. Its always much appreciated when they do so there is early treatment, but they should be referring you to a specialist, says Lee.
If you, as an older patient, feel your symptoms are not being well controlled, bring it up to your physician. If your doctor dismisses your concerns with Youre 78, thats what 78 feels like, look for another doctor. Domingues says patients need to be empowered to speak for themselves. You have to voice your concerns about trying to differentiate what is inflammatory arthritis, and what is osteoarthritis, regardless of age. You should mention to your doctor if treatment is not working, you're still complaining of joint pain, joint stiffness, and joint swelling. If your doctor continues not to listen, get a second opinion.
Lee adds, We see patients in the office visits but patients live with this on a day-to-day basis. The more aware and informed they are about their symptoms that they can communicate back to the physician is going to really help inform how to optimize medication use.
Read more here:
Rheumatoid Arthritis Is Undertreated in Older Adults - Everyday Health
- Understanding Menopause and its Symptoms | Menopause Treatment Options - Medriva - December 28th, 2023 [December 28th, 2023]
- Breast cancer survivor Jayne Pritchard talks alternative therapies over tea - MidlandToday - December 28th, 2023 [December 28th, 2023]
- 12 unusual ways Israelis are volunteering during the war - ISRAEL21c - December 28th, 2023 [December 28th, 2023]
- Complementary and alternative medicine - NHS - December 26th, 2022 [December 26th, 2022]
- Alternative Treatment (CAM) for MS: Types, Side Effects & Cost - December 26th, 2022 [December 26th, 2022]
- Complementary and alternative medicine | History & Facts - December 26th, 2022 [December 26th, 2022]
- Alternative medicine: Definition, examples, benefits, and risks - October 28th, 2022 [October 28th, 2022]
- Alternative Medicine: The Science Behind 10 Alternative Therapies - October 21st, 2022 [October 21st, 2022]
- Detoxification (alternative medicine) - Wikipedia - October 21st, 2022 [October 21st, 2022]
- Alternative Approaches to Mental Health and Wellbeing - Psychiatric Times - October 19th, 2022 [October 19th, 2022]
- New practice focuses on dental sleep medicine, providing an alternative for patients who use CPAP machines - PennLive - October 19th, 2022 [October 19th, 2022]
- Dr. Deepak Chopra Aligns with Plant-Based Therapeutics Company ProVEDA to Highlight Topical Pain Relief Solutions - Yahoo Finance - October 19th, 2022 [October 19th, 2022]
- True REST Float Spa Offers Free Floatation Therapy Session to Veterans - AccessWire - October 19th, 2022 [October 19th, 2022]
- Youve been told you need surgery for degenerative disc disease and stenosis of the spine. Now what? - Sonoran News - October 19th, 2022 [October 19th, 2022]
- Can you take Paxlovid and heart disease medications at the same time? - Medical News Today - October 15th, 2022 [October 15th, 2022]
- Kardashian fans think theyve unlocked Kourtneys secret to hiding her pregnancy after spotting key detai... - The US Sun - October 15th, 2022 [October 15th, 2022]
- Cabinet approves B5bn for 'Andaman International Health Center' - The Phuket News - October 15th, 2022 [October 15th, 2022]
- Eye health and dynamics of the modern world - The Citizen - October 15th, 2022 [October 15th, 2022]
- The Holistic Review on Occurrence, Biology, Diagnosis, and Treatment of Oral Squamous Cell Carcinoma - Cureus - October 15th, 2022 [October 15th, 2022]
- 10 Deeper Causes of Tinnitus, and How to Treat It - The Epoch Times - October 15th, 2022 [October 15th, 2022]
- Complementary and Alternative Medicine (CAM) - GoodTherapy - October 13th, 2022 [October 13th, 2022]
- India's alternative medicine industry grows, boosted by COVID-19 pandemic - CNA - October 13th, 2022 [October 13th, 2022]
- QC Kinetix (Charlotte) Offers Alternative Treatments for Knee Pain and Sports Injuries - Yahoo Finance - October 13th, 2022 [October 13th, 2022]
- Plant Extracts Market is expected to generate a revenue of USD 85.09 Billion by 2030, Globally, at 6.33% CAGR: Verified Market Research - Yahoo... - October 13th, 2022 [October 13th, 2022]
- Neuroplasticity Nonsense Is Full of Red Flags - Science Based Medicine - October 13th, 2022 [October 13th, 2022]
- Diabetics won't be made to pay for alternative medicines, Pharmac says - Stuff - October 13th, 2022 [October 13th, 2022]
- Lili Reinhart Becomes A Reiki Master: My Journey Into Reiki Healing Cant Be Simplified - IMDb - October 13th, 2022 [October 13th, 2022]
- The DRIPBaR is Coming to Clarksville, TN on Oct 16, 2022 - PR Web - October 13th, 2022 [October 13th, 2022]
- How Dr. Oz Boosted an Osteopath Who Became a Top Spreader of Covid Misinformation Mother Jones - Mother Jones - October 13th, 2022 [October 13th, 2022]
- World Arthritis Day: Arthritis and Women - Times of India - October 13th, 2022 [October 13th, 2022]
- What Is Alternative Medicine? - American Cancer Society - October 6th, 2022 [October 6th, 2022]
- Herbal medicine: Types, uses, and safety - Medical News Today - October 6th, 2022 [October 6th, 2022]
- WCI Health LLC, Your Alternative Health and Wellness Hub Will Be a Vendor and Presenter at Wonderland Miami by Microdose - StreetInsider.com - October 6th, 2022 [October 6th, 2022]
- The Viral Real - Journal #130 October 2022 - E-Flux - October 6th, 2022 [October 6th, 2022]
- Pregabalin Market to Grow by USD 153.03 Mn from 2022 to 2026, Driven by Presence of Large Patient Pool Related To Neuropathic Pain - Technavio - Yahoo... - October 6th, 2022 [October 6th, 2022]
- Woman, 37, dies after herbal supplements led to liver failure: coroner - Insider - October 6th, 2022 [October 6th, 2022]
- What Is Vitiligo? All About This Unique Skin Condition That Impacts Skin Pigmentation, and How To Treat It - Parade Magazine - October 6th, 2022 [October 6th, 2022]
- Herbalist's Resource Guide to Cannabis and Other Plants That Can Prevent Cancer - PR Web - October 6th, 2022 [October 6th, 2022]
- Tasly Pharmaceuticals to Exhibit at BioJapan 2022 -- Bio-Pharmaceutical Company to Join with Maryland-Bas - Benzinga - October 6th, 2022 [October 6th, 2022]
- "Sh*t, I just want to get better. Thats what pushed me to do it, and it worked well" Chauncey Billups and other NBA stars on acupuncture -... - October 6th, 2022 [October 6th, 2022]
- People Science and Symbiome Partner to study the microbiome in the real world - Benzinga - October 6th, 2022 [October 6th, 2022]
- Bob Newhart Proves 93 Is the New 39 - Eat This, Not That - September 29th, 2022 [September 29th, 2022]
- Medical cannabis could be better alternative to opioids in managing pain - The Tribune India - September 29th, 2022 [September 29th, 2022]
- Woman killed by herbal remedies she took to treat arthritis - Evening Standard - September 29th, 2022 [September 29th, 2022]
- Get To Know The Best Natural Adderall Alternatives - Over The Counter and Non Prescription - Outlook India - September 29th, 2022 [September 29th, 2022]
- King Charles III Has a History of Promoting 'Quackery' Alternative Medicine - Newsweek - September 9th, 2022 [September 9th, 2022]
- Remedy Place: The Fashionable Social Wellness Club Where You Can Bring All Your Friends - Vogue - September 9th, 2022 [September 9th, 2022]
- Thailand heightens its healthcare hub ambition with integrative medicine - PR Newswire UK - September 9th, 2022 [September 9th, 2022]
- How bogus cancer treatments prey on the most vulnerable - Coda Story - September 9th, 2022 [September 9th, 2022]
- Management of Chronic Migraine in Children and Adolescents | PHMT - Dove Medical Press - September 9th, 2022 [September 9th, 2022]
- Mouth Taping: Is It Safe? - Health Essentials - September 9th, 2022 [September 9th, 2022]
- Queen Elizabeth: Seven things you need to know about the Queens passing - Toronto Star - September 9th, 2022 [September 9th, 2022]
- Building an Alternative Medical Economy in Response to 'Tyranny': Telehealth CEO - The Epoch Times - August 30th, 2022 [August 30th, 2022]
- Sesame oil: Nutrition, benefits, and more - Medical News Today - August 30th, 2022 [August 30th, 2022]
- Regenerative Medicine: An alternative to surgery and pills | Loop Cayman Islands - Loop News Cayman - August 30th, 2022 [August 30th, 2022]
- Find Euphoria: the luxury Greek spa retreat to visit now - Tatler - August 30th, 2022 [August 30th, 2022]
- What Is Synthetic Urine & How Does It Help To Pass A Drug Test? - The Island Now - August 30th, 2022 [August 30th, 2022]
- The science behind the healthtech startup must be understood well - Express Healthcare - August 30th, 2022 [August 30th, 2022]
- Best-in-class second-line HIV treatment rolls out in Zambia and Nigeria - Clinton Health Access Initiative - August 30th, 2022 [August 30th, 2022]
- Therapeutic effect of HFNC and NIV in patients with AECOPD | COPD - Dove Medical Press - August 30th, 2022 [August 30th, 2022]
- Five years after Kymriah: Ensuring the next cell and gene therapies reach patients - STAT - August 30th, 2022 [August 30th, 2022]
- Meet these renowned healthcare professionals who assist us in leading healthier lives - Oneindia - August 30th, 2022 [August 30th, 2022]
- Diet and Vitiligo: The Story So Far - Cureus - August 29th, 2022 [August 29th, 2022]
- Fatphobia Sucks, Especially If You're Trying to Have a Baby - VICE - August 29th, 2022 [August 29th, 2022]
- Orthomolecular Medicine, A Predictive Tool - Nation World News - August 29th, 2022 [August 29th, 2022]
- COVID-19 vaccines and the Nuremberg Code - Science Based Medicine - August 29th, 2022 [August 29th, 2022]
- Bolstering the Blood-CNS Barrier Could Lead to New Treatment Approach for Multiple Sclerosis - University of Utah Health Care - August 29th, 2022 [August 29th, 2022]
- Lockdowns Postponed the Inevitable. Is That a Bad Thing? - Science Based Medicine - August 29th, 2022 [August 29th, 2022]
- The Impact of Complementary and Alternative Medicine on Insomnia: A Systematic Review - Cureus - August 27th, 2022 [August 27th, 2022]
- Ayurveda As Alternative Medicine: Research And Development To Be Taken Ahead By Heal In India - Entrepreneur - August 27th, 2022 [August 27th, 2022]
- French Doctolib platform accused of 'promoting alternative medicine' - The Connexion - August 27th, 2022 [August 27th, 2022]
- Chronic Fatigue Syndrome: Best Ways for Treating This Condition - Healthline - August 27th, 2022 [August 27th, 2022]
- Ellen White reveals "traumatic" incident that played huge role in her retirement - GIVEMESPORT - August 27th, 2022 [August 27th, 2022]
- Curcumin and Non-Hodgkin's Lymphoma: Does It Help? - Healthline - August 27th, 2022 [August 27th, 2022]
- In Denial: When Patients Don't Want to Believe They Have Cancer - Medscape - August 27th, 2022 [August 27th, 2022]
- Piotr Szyhalski depicts living through COVID-19 and other extreme historical phenomena - MinnPost - August 27th, 2022 [August 27th, 2022]
- Researchers identify chemo alternative for targeted treatment of leukemia patients - Devdiscourse - August 27th, 2022 [August 27th, 2022]
- India Can Show The World The Right Path For Medical Pluralism - News18 - August 27th, 2022 [August 27th, 2022]
- Complementary and Integrative Medicine - Reeve Foundation - Christopher Reeve Foundation - August 23rd, 2022 [August 23rd, 2022]
- Back pain: Exploring alternative treatments - Health - Life & Style - Ahram Online - August 23rd, 2022 [August 23rd, 2022]