IN older adults with newly diagnosed late-onset rheumatoid arthritis (LORA), long-term glucocorticoid (GC) use remains persistent for a notable subset, according to a new analysis of national Medicare data spanning nearly a decade. The findings highlight significant disparities in treatment and raise concerns about barriers to accessing disease-modifying therapies.
The study, based on a 20% sample of Medicare beneficiaries from 2008 to 2017, examined 15,425 individuals aged 66 and older who were newly diagnosed with LORA. Researchers tracked oral glucocorticoid use over the first year after diagnosis, specifically prescriptions exceeding 5 mg/day of prednisone equivalent for 30 days or more per quarter.
Among patients who initiated disease-modifying antirheumatic drugs (DMARDs), comprising 62.5% of the cohort, long-term GC use dropped from 44.1% in the first quarter post-diagnosis to 24.9% by the fourth quarter. In contrast, the reduction was more modest among those not treated with DMARDs, declining from 25.8% to 17.9%.
However, the concern lies in persistence: 13.5% of DMARD-exposed and 9.8% of DMARD-unexposed patients remained on long-term glucocorticoids throughout the year. For these individuals, steroid-sparing strategies were not effectively implemented—often due to financial and clinical hurdles. Specifically, persistent GC use among DMARD-exposed patients was significantly associated with receiving a low-income subsidy, suggesting affordability may hinder access to optimal treatment. In the DMARD-unexposed group, a greater comorbidity burden predicted continued steroid use.
These results underline the complexity of RA management in older adults, where financial constraints and multimorbidity can limit the adoption of best-practice pharmacologic strategies. Persistent glucocorticoid use poses well-known risks in this population, including osteoporosis, cardiovascular events, and diabetes, making targeted interventions crucial.
As clinicians strive for early DMARD initiation and steroid minimization, this study reinforces the importance of identifying patients at risk for prolonged GC exposure and addressing the systemic barriers they face.
Reference: Lee J et al. Changes in Long-Term Glucocorticoid Use Among Older Adults After New Diagnosis of Late-Onset Rheumatoid Arthritis. ACR Open Rheumatol. 2025;7(3):e70013.
