Clinical Edge

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Prevalence of Polypharmacy Elevated in Patients With RA

There is a high prevalence of polypharmacy in rheumatoid arthritis (RA), a new study found. The cross-sectional, multicenter study evaluated the prevalence and factors associated with polypharmacy in a population in a real-life setting in Brazil. Patients underwent clinical evaluation and medical records analysis. Among the findings.

  • 792 patients (median age 56.6 years, 89% female) were evaluated.
  • Median duration of disease was 12.7 years, 78.73% had a positive rheumatoid factor.
  • 67.9% of patients used ≥5 drugs.
  • Polypharmacy demonstrated a relationship with a number of comorbidities and use of specific drugs (corticosteroids, methotrexate, and biological DMARDs).


Gomides AMP, et al. High levels of polypharmacy in rheumatoid arthritis – a challenge not covered by current management recommendations: Data from a large real-life study. [Published online ahead of print August 26, 2019]. J Pharm Pract. doi: 10.1177/0897190019869158.


Treatment of RA often requires use of more than 1 medication to control disease activity. This Brazilian study evaluated a large number of RA patients in Brazil for use of multiple medication, or polypharmacy. Patients on average used 2.8 medications, though the most common co-prescribed medications were folic acid, calcium, and vitamin D. While the authors raise the valid concern of monitoring multiple medications in patients with complex disease, these medications are perhaps less worrisome than some others used to control pain and disease activity. Of note, elderly patients had a higher proportion of polypharmacy than non-elderly patients, which may be due to disease activity as well as higher incidence of comorbidities. In addition, use of medications to treat osteoporosis and dyslipidemia may in fact be highly necessary considering the association of RA with glucocorticoid use, concomitant osteoporosis, and cardiovascular disease. We should be aware of these tendencies but must balance concerns with the need to adequately treat RA and its associated complications. —Arundathi Jayatilleke, MD