# Evaluation of treatment patterns and prescription medication use among older adults with late-onset rheumatoid arthritis

> **NIH NIH R03** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2021 · $153,928

## Abstract

PROJECT SUMMARY / ABSTRACT
Rheumatoid arthritis (RA) is a chronic, debilitating and costly disease that disproportionally affects older adults.
Disease modifying antirheumatic drugs (DMARDs) improve outcomes of RA and, in recent years, the treatment
paradigm has evolved to promote early initiation, escalation, and combination of DMARDs. And yet, older adults
are less likely to receive aggressive treatment due to issues of polypharmacy and multimorbidity. Older adults
with late-onset RA (LORA) experience higher disease activity, more radiographic progression, and greater
functional decline. Thus, less aggressive treatment raises greater concerns for poorer outcomes and greater
levels of disability among older adults with LORA. In addition to achieving disease remission, pain control is an
important goal in the treatment of RA and prescription medications including NSAIDS, glucocorticoids and
opioids are in common use among patients with RA. However, these prescription medications are generally
considered inappropriate for use in older adults because of associated adverse effects such as risk of falls,
fractures and osteoporosis. Moreover, older adults have more limited tolerance to common adverse effects of
medications and are more prone to the additive or even multiplicative risk of polypharmacy, further complicating
the care of medically complex older adults with RA. Information on use of DMARDs for new diagnosis of LORA,
and potential unintentional reliance on other prescription medication use is scarce because older adults are often
excluded from randomized controlled trials. This leaves a gap in our understanding of how, in the face of
polypharmacy and multimorbidity, variation in patterns of treatment impact outcomes for medically complex older
adults with RA. In the absence of trial data, large observational studies that leverage administrative data serve
an important role in filling this type of scientific knowledge gap and also allow for understanding drivers of
treatment choices in usual care. In this retrospective cohort study using Medicare data we propose to achieve 2
aims. In Aim 1, we will characterize patterns of and factors associated with DMRADs and other prescription
medication use among older adults with a new diagnosis of LORA. And in Aim 2 we will compare outcomes
related to treatment and timing of DMARD-initiation for new cases of LORA. This proposal provides a real-world
and population-level study of the care received by older RA patients treated with DMARDs. Preliminary data and
analyses obtained from this study will form the basis of future career development awards to address unique
challenges related to prescribing high risk medications for older adults. Support from the GEMSSTAR award,
mentorship, and training will be invaluable as I progress towards a career as an independent researcher focused
on the design, implementation and evaluation of care models to improve quality of care in older patients with
rheumatic disea...

## Key facts

- **NIH application ID:** 10263306
- **Project number:** 5R03AG067975-02
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** JIHA LEE
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $153,928
- **Award type:** 5
- **Project period:** 2020-09-15 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10263306

## Citation

> US National Institutes of Health, RePORTER application 10263306, Evaluation of treatment patterns and prescription medication use among older adults with late-onset rheumatoid arthritis (5R03AG067975-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10263306. Licensed CC0.

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