ArticleArthritis care & research2021
Variability in Glucocorticoid Prescribing for Rheumatoid Arthritis and the Influence of Provider Preference on Long-Term Use of Glucocorticoids.
Article in Arthritis care & research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 26 citations in OpenAlex.
- Association Between Glucocorticoid Exposure and Objective Sleep Architecture in Rheumatoid Arthritis: An Exploratory Pilot EEG Study.Journal of clinical medicine · 2026Article
- Evaluation of large Language model performance on Persian rheumatology board exams: accuracy and clinical reasoning of GPT-4o vs. GPT-5.1.Scientific reports · 2026Article
- Single high-dose intramuscular injection versus short-term low-dose oral glucocorticoids as bridging therapy in active rheumatoid arthritis: a retrospective cohort study on remission induction.Clinical rheumatology · 2026Article
- Agreement of Administrative Pharmacy Dispensing With Self-Reported Use of Oral Prednisone in US Veterans With Rheumatoid Arthritis.Arthritis care & research · 2025Article
- The impact of aging and glucocorticoid use on physical function of older rheumatoid arthritis in remission: analysis of a National Database of Rheumatic Disease in Japan.Clinical rheumatology · 2025Article
- A national cross-sectional study of the role of clinician specialty and facility complexity on glucocorticoid prescribing in Veterans.Communications medicine · 2025Article
- Changes in Long-Term Glucocorticoid Use Among Older Adults After New Diagnosis of Late-Onset Rheumatoid Arthritis.ACR open rheumatology · 2025Article
- Pharmacological pain management in patients with rheumatoid arthritis: a narrative literature review.BMC medicine · 2025Review
- Lowering Expectations: Glucocorticoid Tapering Among Veterans With Rheumatoid Arthritis Achieving Low Disease Activity on Stable Biologic Therapy.ACR open rheumatology · 2023Article
- Researchers in rheumatology should avoid categorization of continuous predictor variables.BMC medical research methodology · 2023Article
- Fibromyalgianess and glucocorticoid persistence among patients with rheumatoid arthritis.Rheumatology (Oxford, England) · 2022Article
- Glucocorticoid and opioid use in rheumatoid arthritis management.Current opinion in rheumatology · 2021Review
- Risk for infections with glucocorticoids and DMARDs in patients with rheumatoid arthritis.RMD open · 2021Review
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 1 country.
Funding
Abstract
objectiveGlucocorticoids are recommended for short-term use in rheumatoid arthritis (RA), but many patients continue receiving long-term therapy. We evaluated the variability in glucocorticoid prescribing across rheumatologists to inform interventions to limit long-term glucocorticoid use to the lowest dose necessary.
methodsTwo cohorts were created using Medicare data from 2006 to 2015. Using cohort 1 (RA patients receiving disease-modifying antirheumatic drugs [DMARDs]), we calculated each rheumatologist's "provider preference" for glucocorticoids (frequency of use compared to other providers), using the ratio of observed to expected number of patients receiving glucocorticoids to account for case mix. In cohort 2 (RA patients receiving stable DMARD therapy), we evaluated whether provider preference for glucocorticoids could independently predict use of ≥5 mg/day of glucocorticoids 6-9 months after initiation of DMARD therapy.
resultsUsing cohort 1 (1,272,644 yearly observations; 385,597 patients), we calculated provider preference among 6,875 rheumatologists (28,936 yearly observations). Provider preference was highly variable, with physicians at the lowest and upper quartiles prescribing glucocorticoids 33% less often to 31% more often (25th and 75th percentiles, respectively) than expected. In cohort 2 (155,539 patients receiving stable DMARD therapy), provider preference was strongly associated with glucocorticoid use ≥5 mg/day at 6-9 months, with a predicted probability of use of 22% (95% confidence interval [95% CI] 21.7-22.7) versus 11% (95% CI 10.2-10.9) for a patient seeing a provider in the highest versus lowest quintile of preference.
conclusionGlucocorticoid prescribing for RA varies greatly among rheumatologists, and provider preference is one of the strongest predictors of a patient's long-term glucocorticoid use. These findings raise quality of care concerns and highlight the need for stronger evidence to guide RA treatment.
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