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Disparity in RA as measured by function if there is inferior health insurance

February 19 2016 2:57 AM ET via RheumReports RheumReports

It has been shown that in Canada (in various provinces), there is a delay in access to biologics according to type of health insurance. For instance, in Ontario, if a patient has government coverage, they receive their biologic treatment months after those who have private insurance. The BIOTRAC registry of more than 1000 patients with RA, PsA and SpA compared insurance type with Health Assessment Questionnaire (HAQ) scores and found that the baseline function as measured by HAQ was worse in those with public vs. private insurance. In fact, a predictor of change in HAQ when adjusting for confounders was insurance type (J Stewart, et al. Variability in HAQ based on type of insurance coverage).

Using the same registry, M Starr et al. compared those who failed to achieve remission using CDAI and SDAI based on the MD global. Only 8% did not achieve remission based on the physician global assessment. If the MD global was not included there could be over-treatment as the other measures such as patient global were more apt to be the reason for non-remission to occur.

So what do you do if an RA patient is on a biologic and is losing disease control?

J Carter Thorne et al. studied 429 RA patients in clinical practice receiving etanercept (156), adalimumab (126) and infliximab (32). Not surprisingly, dose escalation occurred during flares in patients using infliximab whereas comedication with concomitant DMARDs was increased if the patient was receiving etanercept or adalimumab. We don't dose escalate medications when there is not access or data in RA supporting higher dosing. However, many patients were able to regain improvement and maintain their current biologic treatment by treating their disease during a flare.


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About the Author

Dr. Janet Pope
Dr. Janet Pope

Dr. Janet Pope is Professor of Medicine at Western University and Division Head of Rheumatology. Dr. Pope's research interests include epidemiologic studies in scleroderma, classification criteria in systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis.

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