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Rheumatology Advance Access originally published online on May 28, 2009
Rheumatology 2009 48(8):906-910; doi:10.1093/rheumatology/kep129
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Missed opportunities in the treatment of elderly patients with rheumatoid arthritis

Beáta J. Radovits1, Jaap Fransen1, Agnes Eijsbouts2, Piet L. C. M. van Riel1 and Roland F. J. M. Laan1

1Department of Rheumatology, Radboud University Nijmegen Medical Centre and 2Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.

Correspondence to: Beata J. Radovits, Department of Rheumatology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, Hp 470, 6500 HB Nijmegen, The Netherlands. E-mail: B.Radovits{at}reuma.umcn.nl; bradovits{at}hotmail.com


  Abstract

Objective. To investigate whether there is a difference in waiting time between indication and start of anti-TNF-{alpha} therapy in younger and older RA patients.

Methods. The study was carried out in the Nijmegen inception cohort of early RA. All patients meeting indications for anti-TNF-{alpha} therapy according to the Dutch reimbursement criteria were included in the analysis. Time from indication to start of anti-TNF-{alpha} therapy or censoring was calculated in all patients. Multivariable Cox regression analysis was used to investigate the influence of age at indication on the time to commencement of anti-TNF-{alpha} treatment. Hazard ratios were calculated for groups in age quartiles. The model was corrected for 28-joint disease activity score (DAS28), disease duration, gender, the Charlson comorbidity index and episodes of serious illnesses between indication and anti-TNF-{alpha} therapy or censoring.

Results. From the 487 eligible patients, 215 patients started anti-TNF-{alpha} treatment during their follow-up (44%). Age significantly influenced the time to receiving anti-TNF-{alpha} after first indication, adjusting for confounders (HR = 0.975/year, P < 0.001). The same analysis using age quartiles showed that the younger age groups had a higher chance of receiving anti-TNF-{alpha} treatment within an equal period of time than older patients [HR 2.67 (95% CI 1.64, 4.35); 2.30 (1.43, 3.71); 1.79 (1.14, 2.81) with increasing age; the eldest group as reference]. The eldest patients had significantly higher DAS28 values prior to anti-TNF-{alpha} treatment than younger patients.

Conclusion. Elderly RA patients were less likely to receive anti-TNF-{alpha} treatment within an equal period of time compared with younger patients, taking disease activity, disease duration and comorbidities into account.

KEY WORDS: Rheumatoid arthritis, Decision making, Elderly, Anti-TNF-{alpha} treatment, Indication

Submitted 18 November 2008; revised version accepted 21 April 2009.
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