title: Missed opportunities in the treatment of elderly patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To investigate whether there is a difference in waiting time between indication and start of anti-TNF-alpha therapy in younger and older RA patients.
  
  
  METHODS
  The study was carried out in the Nijmegen inception cohort of early RA. All patients meeting indications for anti-TNF-alpha therapy according to the Dutch reimbursement criteria were included in the analysis. Time from indication to start of anti-TNF-alpha therapy or censoring was calculated in all patients. Multivariable Cox regression analysis was used to investigate the influence of age at indication on the time to commencement of anti-TNF-alpha treatment. Hazard ratios were calculated for groups in age quartiles. The model was corrected for 28-joint disease activity score (DAS28), disease duration, gender, the Charlson comorbidity index and episodes of serious illnesses between indication and anti-TNF-alpha therapy or censoring.
  
  
  RESULTS
  From the 487 eligible patients, 215 patients started anti-TNF-alpha treatment during their follow-up (44%). Age significantly influenced the time to receiving anti-TNF-alpha after first indication, adjusting for confounders (HR = 0.975/year, P < 0.001). The same analysis using age quartiles showed that the younger age groups had a higher chance of receiving anti-TNF-alpha treatment within an equal period of time than older patients [HR 2.67 (95% CI 1.64, 4.35); 2.30 (1.43, 3.71); 1.79 (1.14, 2.81) with increasing age; the eldest group as reference]. The eldest patients had significantly higher DAS28 values prior to anti-TNF-alpha treatment than younger patients.
  
  
  CONCLUSIONS
  Elderly RA patients were less likely to receive anti-TNF-alpha treatment within an equal period of time compared with younger patients, taking disease activity, disease duration and comorbidities into account.
authors.affiliation: Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. B.Radovits@reuma.umcn.nl
authors.forename: Beáta J
authors.initials: BJ
authors.lastname: Radovits
authors.forename: Jaap
authors.initials: J
authors.lastname: Fransen
authors.forename: Agnes
authors.initials: A
authors.lastname: Eijsbouts
authors.forename: Piet L C M
authors.initials: PL
authors.lastname: van Riel
authors.forename: Roland F J M
authors.initials: RF
authors.lastname: Laan
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D015897:Comorbidity; D011307:Drug Prescriptions; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha