title: Half of U.K. patients with rheumatoid arthritis are prescribed oral glucocorticoid therapy in primary care: a retrospective drug utilisation study.
abstract: BACKGROUND
  Patients with rheumatoid arthritis (RA) have shared care between rheumatologists and general practitioners (GPs). Rheumatologists guide immunosuppressive therapy, whilst GPs rely on analgesia and glucocorticoid (GC) therapy to manage active disease. The objective of this study was to describe patterns of GC prescribing for patients with RA in primary care and to determine the influence of patient characteristics and prescriber.
  
  
  METHODS
  Incident RA patients were identified within the Clinical Practice Research Datalink, a United Kingdom (UK) primary care research database. Descriptive statistics identified patterns of oral GC prescribing. Prescribers were categorised by their tendency to prescribe GCs (high/low). Logistic regression was used to identify baseline characteristics associated with GC prescriptions during follow-up and to examine whether baseline characteristics influenced prescribing differently in high versus low prescribers.
  
  
  RESULTS
  A total of 7777 patients (47%) received ≥1 GC prescription during follow-up. The average daily dose was 7.5 mg (IQR 5-15.3 mg). Of those who received GCs, >50% were prescribed >10 mg/day and 20 % >30 mg/day. The median proportion of time spent on GCs was 26.3% (IQR 3.8-70.0%). Age and cardiovascular disease (CVD) were associated with increased likelihood of receiving GCs. High prescribers more commonly prescribed GC therapy in older patients and patients with hypertension.
  
  
  CONCLUSIONS
  Half of patients with incident RA received GCs in primary care. Average GC use was 7.5 mg for 25% of the time, perhaps higher usage than rheumatologists and GPs might expect. GCs were prescribed more commonly in certain high-risk populations, including older patients and those with CVD.
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Oxford Rd, Manchester, M13 9PT, UK. rachelblack@mail.com.|Department of Medicine, The University of Adelaide, Adelaide, SA, 5005, Australia. rachelblack@mail.com.|Department of Rheumatology, The Basil Hetzel Institute for Translational Health Research, Woodville Rd, Woodville South, SA, 5011, Australia. rachelblack@mail.com.
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Black
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Oxford Rd, Manchester, M13 9PT, UK. Rebecca.joseph@manchester.ac.uk.|NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, 29 Grafton Street, Manchester, M13 9WU, UK. Rebecca.joseph@manchester.ac.uk.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Joseph
authors.affiliation: Health e-Research Centre, Farr Institute for Health Informatics Research, Manchester Academic Health Science Centre, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK. Benjamin.brown@manchester.ac.uk.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Brown
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Oxford Rd, Manchester, M13 9PT, UK. Mohammad.Movahedi@uhnresearch.ca.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Movahedi
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Oxford Rd, Manchester, M13 9PT, UK. Mark.lunt@manchester.ac.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Lunt
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Oxford Rd, Manchester, M13 9PT, UK. Will.dixon@manchester.ac.uk.|NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, 29 Grafton Street, Manchester, M13 9WU, UK. Will.dixon@manchester.ac.uk.|Health e-Research Centre, Farr Institute for Health Informatics Research, Manchester Academic Health Science Centre, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK. Will.dixon@manchester.ac.uk.|Department of Rheumatology, Salford Royal NHS Foundation Trust , Stott Lane, Salford, M6 8HD, UK. Will.dixon@manchester.ac.uk.
authors.forename: William G
authors.initials: WG
authors.lastname: Dixon
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D058005:General Practitioners; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D006113:United Kingdom
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids