Fewer DMARDs Prescribed for African Americans and in Nonrheumatologist RA Visits

Fewer than half of patient visits to US physicians with a diagnosis of rheumatoid arthritis (RA) in a nationally representative sample were associated with a disease-modifying antirheumatic drug (DMARD). DMARDs were prescribed much less often for African Americans than for white persons, especially in visits to nonrheumatologists, suggesting that African Americans may be associated with reduced DMARD use, partly because they have more limited access to rheumatologists.

Solomon and associates analyzed visit data from 1996 through 2007 if the physician noted a diagnosis of RA. DMARD use was based on the medications listed by the physician.

There was an associated DMARD in 47% of the visits. The percentage of RA visits with DMARDs increased slightly over the 12 years; biologic DMARDs increased to 20% of visits after their introduction. African American race was associated with a 30% reduction in DMARD prescribing. A visit to a rheumatologist was the strongest correlate of DMARD prescribing. African Americans were significantly less likely than white persons to receive a DMARD among visits to nonrheumatologists but not among visits to rheumatologists.

The authors suggested that interventions be considered to improve DMARD prescribing, especially for patients who do not see rheumatologists and for African American patients.