Effectiveness of DMARDs in treating Rheumatoid Arthritis in older adults in Australia

This study aims to compare the effectiveness of DMARDs as a complete intervention to treat Rheumatoid Arthritis (RA) in aged people in Australia. Findings suggest DMARDs slow progression of the disease and delay damage of bone and cartilage with less side effects. The study analyzes the use of DMARDs in patients with RA and the combination of DMARDs and NSAIDs. The PICO question is whether DMARDs are useful in improving the condition in aged people with less or no side effects compared to NSAIDs. The search strategy includes PubMed and CINAHL databases. The best practice is to use DMARDs as the standard therapy for RA. The findings suggest that DMARDs improve RA patient condition in the presence of TNF1 inhibitors.

Running head:RHEUMATOID ARTHRITIS
RHEUMATOID ARTHRITIS
Name of the Student
Name of the university
Author’s note

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Introduction
Rheumatoid arthritis is a progressive anti-inflammatory autoimmune disease and occurs
mostly in older adults. The inflammation of the joint causes swelling and pain. According to the
data of World Health Organization, more than 13 million people only in America is suffering
from this disorder and due to its autoimmune nature, it is not possible to invent one intervention
that can improve the health of affected patient
1. Problem: according of the Australian ministry of Health and Welfare , more than 9% of
total Australian population is suffering from rheumatoid arthritis and within that
maximum (10.2%) are aged person (from 50 to 75). It was further responsible for 6410
deaths in Australia in the year 2014.
2. Solution: one approach to deal with rheumatoid arthritis is to Use DMARDs drugs over
NSAIDs drugs in the treatment of RA.
3. Aim: this study aims to compare the effectiveness of DMARDsas a complete
intervention to treat RA in aged people in Australia.
PICO question
Define your PICO
Population Older people in Australia
Intervention Use of DMARDs drugs in the treatment of RA.
Comparison/Control Patients having RA, taking DMARD medicine such as
Methotrexate and those who are not being treated with the drug

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Outcome Improvement in pain and swelling and less usage of other
interventions .
Write your research question below in the PICO format
In rheumatoid arthritis situation, Are DMARDs compared toNSAIDs are useful in improving
the condition in aged peoplewith less or no side effects?
P: older adults of Australia
I: DMARDS (eg:Methotrexate)
C:NSAIDs (eg:Ibuprofen)
O: improved rheumatoid arthritis
Search Strategy
2 main databases, PubMed and CINAHL were brainstormed through for searching the
relevant journal articles. PubMed was searched using the MESH terms- Methotrexate,
Rheumatoid arthritis/ old aged women, Rheumatoid arthritis/ DMARDs. The other Key words
used were Rheumatoid arthritis in women, NSAIDs in RA, harmful effects of NSAIDs,
DMARDs. The limiters used were full text peer reviewed journals within the years 2012-2018.
Best Practice
Best Practice Level of Evidence and Type
of Study
Citation in CDUAPA 6th
format
Solomon, D. H., Ayanian, J. Z.,
Yelin, E., Shaykevich, T.,
Brookhart, M. A., & Katz, J. N.
(2012). Use of Disease-
Modifying Medications for
Rheumatoid Arthritis by Race
and Ethnicity in the National
Ambulatory Medical Care
Level IV
Case control study
(Solomon et al., 2012)

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Survey. Arthritis Care &
Research, 64(2), 184–189.
http://doi.org/10.1002/acr.20674
Cho, S. K., Sung, Y. K., Kim,
D., Won, S., Choi, C. B., Kim, T.
H., ... &Bae, S. C. (2016). Drug
retention and safety of TNF
inhibitors in elderly patients with
rheumatoid arthritis. BMC
musculoskeletal disorders, 17(1),
333.
https://doi.org/10.1186/s12891-
016-1185-6
Level I
RCT
(Cho et al., 2016)
Nash, P., Nayiager, S.,
Genovese, M. C., Kivitz, A. J.,
Oelke, K., Ludivico,
C., ...&Corbo, M. (2013).
Immunogenicity, Safety, and
Efficacy of Abatacept
Administered Subcutaneously
With or Without Background
Methotrexate in Patients With
Rheumatoid Arthritis: Results
From a Phase III, International,
Multicenter, Parallel‐Arm, Open‐
Level I
RCT
(Nash et al., 2013)

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Label Study. Arthritis care &
research, 65(5), 718-728.
https://doi.org/10.1002/acr.2187
6
Findings
According to the article by Solomon et al.,(2012), the use of the DMARDs represents the
standard therapy for RA, having the ability to reduce pain and disability and the traditional
model of RA treatment is the application of NSAIDs and glucocorticoids in the first place. The
advantages of using DMARDs over NSAIDs lie with the fact that it helps in the slow progression
of the disease and delays the damage of the bone and the cartilage in the joints. The action of the
DMARDs might not be as quick as the NSAIDs, but its side effects are less than that of NSAIDs.
Often a combination of DMARDs and NSAIDs are taken to reduce the clinical condition of
Rheumatoid arthritis. This study studies the use of the DMARDs in patient with RA where 859
patients were analyzed for the application of the DMARDs and it was found that among the 859
visits only 404 participants had an associated DMARD alongside with NSAIDs.
As stated by Cho et al., (2016), the researchers divided 429 RA patients treated with TNF
inhibitors into two groups. The group 1 included aged people whereas the group 2 was consist of
younger generation. The mean observational period was 24 months, with 23.8 ± 25.8 months in
the elderly group and 23.3 ± 23.2 months in the younger group.In this situation, the older adults
were provided with DMARD drugs and it was found that in the combination they are able to
improve patient condition. However stopping any one intervention can generate adverse effects

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in patients. Hence, it was determined that DMARD was able to improve RA patient condition in
the presence of TNF1 inhibitors.
According to Nash et al., (2013) administration of the DMARDs such as methotrexate
along with the medications like infliximab or golimumab is prescribed for RA for maintaining
the clinical efficacy. As per an open label study, RA patients were classified to get
Subcutanousabacept with or without methotrexate. The paper could not validate the efficacy of
DMARDs as Sc was not found to responsible for eliciting immunogenicity related to the loss of
efficacy with or without Methotrexate.

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References
Cho, S. K., Sung, Y. K., Kim, D., Won, S., Choi, C. B., Kim, T. H., ... &Bae, S. C. (2016). Drug
retention and safety of TNF inhibitors in elderly patients with rheumatoid arthritis. BMC
musculoskeletal disorders, 17(1), 333. https://doi.org/10.1186/s12891-016-1185-6
Nash, P., Nayiager, S., Genovese, M. C., Kivitz, A. J., Oelke, K., Ludivico, C., ...&Corbo, M.
(2013). Immunogenicity, Safety, and Efficacy of Abatacept Administered
Subcutaneously With or Without Background Methotrexate in Patients With Rheumatoid
Arthritis: Results From a Phase III, International, Multicenter, Parallel‐Arm, Open‐Label
Study. Arthritis care & research, 65(5), 718-728. https://doi.org/10.1002/acr.21876
Solomon, D. H., Ayanian, J. Z., Yelin, E., Shaykevich, T., Brookhart, M. A., & Katz, J. N.
(2012). Use of Disease-Modifying Medications for Rheumatoid Arthritis by Race and
Ethnicity in the National Ambulatory Medical Care Survey. Arthritis Care & Research,
64(2), 184–189. http://doi.org/10.1002/acr.20674