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Does Age Bias the Aggressive Treatment of Elderly Patients with Rheumatoid Arthritis?
MELANIE J. HARRISON, CAROLINE A. KIM, MIRIAM SILVERBERG, and STEPHEN A. PAGET ABSTRACT. Objective. Age bias has been reported to result in undertreatment of elderly patients with various medical conditions. We investigated whether a similar bias exists in the treatment of elderly patients with rheumatoid arthritis (ELDRA) compared to matched younger controls (YRA). Methods. We performed an analysis of our RA clinical research registry to determine whether any differences exist between ELDRA and YRA patients with respect to use of combination disease modifying antirheumatic drugs (DMARD), biologic agents, corticosteroids, and nonsteroidal antiinflammatory drugs (NSAID). We also determined whether any difference in clinical status could be identified. Results. Forty-nine female ELDRA subjects (age > 70 yrs) with insurance were matched for sex, insurance status, and duration of disease to YRA subjects (< 60 yrs). No statistically significant difference was noted in number of DMARD currently in use (1.24 ± 0.78 vs 1.24 ± 0.69, p = 1.00), or number of patients using biologic agents (25 vs 30; p = 0.31), corticosteroids (16 vs 11; p = 0.26), or NSAID (26 vs 36; p = 0.06). ELDRA and YRA patients also reported similar pain (judged using a visual analog scale, VAS; 3.5 ± 2.6 cm vs 3.4 ± 2.2 cm), fatigue (VAS 3.2 ± 2.7 cm vs 3.9 ± 2.9 cm), global assessment (VAS 2.8 ± 2.2 cm vs 3.5 ± 2.6 cm), and Health Assessment Questionnaire disability scores (0.82 ± 0.5 vs 0.73 ± 0.5). Conclusion. In this cohort of elderly patients with RA, we detected no bias in the use of RA treatment compared with younger controls. Clinical RA measures also showed that these elderly patients with RA were faring at least as well as the younger controls; they were not relatively undertreated. (J Rheumatol 2005;32:1243-8) Key Indexing Terms: RHEUMATOID ARTHRITIS From the Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, New York, USA. M.J. Harrison, MD, MS, Assistant Research Professor of Medicine and Public Health, Weill Medical College of Cornell University; C.A. Kim, BA; M.S. Silverberg, MD, Rheumatology Fellow; S.A. Paget, MD, Professor of Medicine, Weill Medical College of Cornell University, Hospital for Special Surgery. Address reprint requests to Dr. M.J. Harrison, Division of Rheumatology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail: harrisonm@hss.edu Accepted for publication February 21, 2005. |