Changes in the pharmacological management of rheumatoid arthritis over two decades.

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To assess whether modern management of rheumatoid arthritis (RA) has reduced the prescription of oral corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) and to evaluate use of pharmacological prophylaxis strategies.Using the Clinical Practice Research Datalink, we explored long-term (≥3/12 months; ≥6/12 in sub-analyses) disease modifying antirheumatic drug (DMARD), corticosteroid and NSAID prescribing (annually, in the year post-diagnosis and across the patient’s life-course to 15 years post-diagnosis), annual proportion with co-prescribing for prophylaxis of associated bone (corticosteroids, women only) and gastrointestinal (NSAIDs) comorbidity.Reported incidence of RA was 5.98 (±0.37) per 10 000 person-years and prevalence was 0.91% (±0.014) in 2017. In 71 411 RA patients, long-term DMARD prescribing initially rose post-diagnosis from 41.6% in 1998-67.9% in 2009. Corticosteroid prescribing changed little, overall (22.2% in 1998, 19.1% in 2016; incident risk ratio (IRR) 0.92, 95% CI 0.82-1.03) and across the life-course from the first to fifteenth year (22.2% to 16.9%). NSAID prescribing declined from 57.7% in 1998, and significantly so from 2008, to 27.1% in 2016 (IRR 0.50, 95% CI 0.44-0.56). This continued across the life-course (41.2% to 28.4%). Bone prophylaxis increased to 68.1% in 2008 before declining to 56.4% in 2017; gastrointestinal prophylaxis increased from 11.5% in 1998-62.6% in 2017. Sub-analyses showed consistent patterns.Despite modern treatment strategies, corticosteroid prescribing in RA patients remains substantial and persists beyond 6 months once initiated. Rheumatologists need to determine causes and develop strategies to reduce corticosteroid use to minimise adverse event occurrence.

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