Related Experiment Video
Updated: Jun 9, 2025
04:50
Preliminary Study on Acupuncture Combined with Grain-sized Moxibustion for Treating Rheumatoid Arthritis with Finger Joint Pain
Published on: May 16, 2025
89
Escalation to Biologics After Methotrexate Among US Veterans With Rheumatoid Arthritis Grouped by Rural Versus Urban
Anisha Naik1, Aaron Baraff1, Katherine D Wysham2
1VA Puget Sound Health Care System, Seattle, Washington.
Arthritis Care & Research
|October 28, 2024
Summary
Urban veterans with rheumatoid arthritis (RA) were slightly more likely to initiate biologic therapies than rural veterans. These modest differences suggest rurality alone doesn't explain RA treatment disparities in the VA system.
Area of Science:
- Rheumatology
- Health Services Research
- Health Disparities
Background:
- Racial and ethnic disparities in rheumatoid arthritis (RA) outcomes are established.
- The impact of urban versus rural residence on RA treatment selection and outcomes, independent of race, remains understudied.
- Understanding these geographic disparities is crucial for equitable RA care.
Purpose of the Study:
- To investigate whether the initiation of biologic disease-modifying antirheumatic drugs (bDMARDs) after methotrexate differs between urban and rural veterans with RA.
- To assess the influence of geographic location on RA treatment patterns within the US Veterans Affairs (VA) healthcare system.
Main Methods:
- Retrospective cohort study utilizing national US Veterans Affairs (VA) databases.
- Included 17,395 adult veterans diagnosed with RA, initiating methotrexate between 2005-2014.
- Analyzed time to biologic initiation within two years using multivariable Cox proportional hazards models, adjusting for covariates.
Main Results:
- Among eligible veterans, 19% initiated a biologic within two years.
- Urban residence was associated with a statistically significant higher rate of biologic initiation compared to rural residence (aHR 1.10 [95% CI 1.02-1.18]).
- The study included a large cohort with a substantial proportion of rural residents (42%).
Conclusions:
- Modest differences were observed in biologic therapy initiation between rural and urban RA patients within the VA system.
- These findings indicate that geographic disparities (rurality) may not be the primary driver of RA treatment differences in this population.
- Further research is needed to explore other factors contributing to potential disparities in RA care.
Related Concept Videos
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
143
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
143
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
117
Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab...
117
01:29Inflammatory Bowel Disease IV: Pharmacological Management
117
Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
Pharmacologic...
117
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
97
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
97
01:24T Cell Types and Functions
955
When T cells with CD4 markers are activated, they give rise to two types of effector cells: helper T cells and regulatory T cells. Meanwhile, T cells with CD8 markers differentiate into effector cytotoxic T cells. The differentiation of CD4 T cells into helper T cell subsets, such as Th1, Th2, and Th17 cells, is dependent on the antigen type, antigen-presenting cell, and regulatory cytokines.
Th1 cells stimulate dendritic cells to express necessary co-stimulatory molecules on their surfaces for...
Th1 cells stimulate dendritic cells to express necessary co-stimulatory molecules on their surfaces for...
955
01:20The JAK-STAT Signaling Pathway
8.7K
Several cytokine receptors have tightly bound Janus kinase or JAK proteins attached at their cytosolic tail. Small signaling molecules such as cytokines, growth hormones, or prolactins bind to the cytokine receptors and initiate their dimerization. The dimerization brings the cytosolic JAKs together that trans-phosphorylate and activates each other. The activated JAKs now phosphorylate cytosolic tails of the cytokine receptors, which serve as binding sites for adaptor proteins such as SH2...
8.7K