Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Delay in DMARD Initiation in Newly Diagnosed RA

Semin Arthritis Rheum; ePub 2018 Jul 18; Kimsey, et al

Delays in initial disease-modifying antirheumatic drug (DMARD) receipt for incident rheumatoid arthritis (RA) were common but time to treatment improved in recent years, according to a recent nationwide study. These recent findings suggest that limiting opioid use in patients newly presenting with RA may decrease delay in initiating DMARDs. Researchers used administrative data from the US military's TRICARE program (2007-2012). They quantified the time between RA presentation and initial DMARD receipt, evaluated temporal changes in delay over the study period, and investigated predictors of treatment delay (>90 days) using logistic regression. They found:

  • 16,680 patients with incident RA that were prescribed DMARDs were identified and mean age was 47.2 (SD 13.5) years.
  • The mean time from initial RA presentation to first DMARD prescription receipt was 125.3 days (SD 175.4).
  • Over one-third (35.6%) of incident RA patients initiated DMARD >90 days after presentation.
  • Patients prescribed opioids had mean time to DMARD of 212.8 days (SD 207.4) compared to mean of 77.3 days (SD 132.3) for those who did not use opioids.
  • Patients prescribed opioids between RA presentation and initial DMARD receipt were more likely to have delay in initial DMARD.


Kimsey L, Weissman JS, Patel A, Drew A, Koehlmoos T, Sparks JA. Delay in initiation of DMARD or anti-inflammatory therapy in patients newly diagnosed with rheumatoid arthritis: An analysis of United States military health system TRICARE beneficiaries. [Published online ahead of print July 18, 2018]. Semin Arthritis Rheum. doi:10.1016/j.semarthrit.2018.07.003.

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