RESEARCH - GI prophylactic therapy among patients with arthritis treated by rheumatology specialists

May 15, 2006

J Rheumatol. 2006 Apr;33(4):779-84. Epub 2006 Mar 1.

Gastrointestinal prophylactic therapy among patients with arthritis treated

by rheumatology specialists.

EB, Michaud K, Wolfe F.

Brigham and Women's Hospital, Boston, Massachusetts, USA.

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.

PMID: 16511939

6511939

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

s Hopkins Medicine

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