title: Gastrointestinal prophylactic therapy among patients with arthritis treated by rheumatology specialists.
abstract: OBJECTIVE
  To determine rates of gastroprotective agent (GPA) use among patients with arthritis treated by rheumatologists, and to determine factors associated with GPA prescription.
  
  
  METHODS
  In a longitudinal outcome study, 11,451 patients with rheumatoid arthritis (RA) and osteoarthritis (OA) reported all medication use, ulcer history, functional status, and sociodemographic characteristics.
  
  
  RESULTS
  GPA were used in 21-24% of all patients with RA and OA and in about 35-40% of all high risk patients. In unadjusted analyses, GPA use was similar among NSAID users and non-users. In multivariable logistic regression analyses GPA use was associated with non-specific (NS) NSAID and COX-2 NSAID, prednisone, low dose aspirin, comorbidity, Health Assessment Questionnaire functional score, age < 65 years, increased income, not smoking, and being male. Despite numerous associations, the explanatory power for GPA use was poor (area under ROC curve = 0.680).
  
  
  CONCLUSIONS
  GPA are used in 35% to 40% of patients with 4 risk factors for gastrointestinal ulceration. GPA use is not increased in NS NSAID users compared to COX-2 NSAID users, and was inversely associated with socioeconomic status. GPA use does not follow the model predicted by clinical trial results with respect to NS NSAID and age, reflecting a change in the pattern of NSAID use in patients with rheumatic disease. The major determinant of GPA use appears to be physician prescribing behavior.
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Elizabeth Benito
authors.initials: EB
authors.lastname: Garcia
authors.forename: Kaleb
authors.initials: K
authors.lastname: Michaud
authors.forename: Frederick
authors.initials: F
authors.lastname: Wolfe
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000188:drug therapy* / Q000503:physiopathology; D010437:Peptic Ulcer / Q000139:chemically induced / Q000517:prevention & control*; D011364:Professional Practice; D012219:Rheumatology / Q000379:methods*; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D018501:Antirheumatic Agents; D005765:Gastrointestinal Agents