{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T04:44:26Z","timestamp":1780980266222,"version":"3.54.1"},"reference-count":39,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T00:00:00Z","timestamp":1741046400000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["K23AR079588"],"award-info":[{"award-number":["K23AR079588"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["IIR 20\u2010256"],"award-info":[{"award-number":["IIR 20\u2010256"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["IK2CX002430"],"award-info":[{"award-number":["IK2CX002430"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K23AG082727"],"award-info":[{"award-number":["K23AG082727"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R03AG067975"],"award-info":[{"award-number":["R03AG067975"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ACR Open Rheumatology"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>We evaluated changes in long\u2010term glucocorticoid (GC) use and factors associated with persistent GC use in older adults with late\u2010onset rheumatoid arthritis (LORA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using 20% Medicare data from 2008 to 2017, we identified adults \u226566 years with a new diagnosis of LORA, disease\u2010modifying antirheumatic drug (DMARD) use or at least two rheumatologist visits, and at least 12 months of follow\u2010up data. Older adults were categorized as <jats:italic>DMARD\u2010exposed<\/jats:italic> or <jats:italic>DMARD\u2010unexposed<\/jats:italic> based on treatment during the 12 months after LORA diagnosis (index date). For each quarter after the index date, <jats:italic>long\u2010term GC use<\/jats:italic> was defined as having oral GC prescriptions for at least 30 days with a dose &gt;5 mg\/day prednisone equivalent. We compared long\u2010term GC use between quarter (Q)1 and Q4 and performed stratified mixed\u2010effects logistic regression for factors associated with <jats:italic>persistent GC use<\/jats:italic>, defined as long\u2010term GC use in Q2 to Q4.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The cohort included 15,425 individuals with two\u2010thirds (62.5%) being DMARD\u2010exposed. Between Q1 and Q4, the proportion of older adults on long\u2010term GC declined from 44.1 to 24.9% (\u220619.2%) among the DMARD\u2010exposed and from 25.8 to 17.9% (\u22067.9%) among the DMARD\u2010unexposed. One year after the index date, 13.5% of the DMARD\u2010exposed and 9.8% of the DMARD\u2010unexposed were persistent GC users. In stratified mixed\u2010effects logistic models, persistent GC use was associated with low\u2010income subsidy status among the DMARD\u2010exposed and with greater comorbidity burden among DMARD\u2010unexposed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Long\u2010term GC use declined more among DMARD\u2010exposed than DMARD\u2010unexposed patients. One in seven DMARD\u2010exposed and one in ten DMARD\u2010unexposed have persistent GC use which is associated with financial barriers and multimorbidity that may limit the use of steroid\u2010sparing DMARDs.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr2.70013","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T17:28:43Z","timestamp":1741714123000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Changes in Long\u2010Term Glucocorticoid Use Among Older Adults After New Diagnosis of Late\u2010Onset Rheumatoid Arthritis"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6402-6563","authenticated-orcid":false,"given":"Jiha","family":"Lee","sequence":"first","affiliation":[{"name":"University of Michigan  Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Martindale","sequence":"additional","affiliation":[{"name":"University of Michigan  Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth I.","family":"Wallace","sequence":"additional","affiliation":[{"name":"University of Michigan, Ann Arbor, and VA Ann Arbor Healthcare System  Ann Arbor Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Namrata","family":"Singh","sequence":"additional","affiliation":[{"name":"University of Washington  Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4750-0777","authenticated-orcid":false,"given":"Una E.","family":"Makris","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center and VA North Texas Health Care System  Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie P.W.","family":"Bynum","sequence":"additional","affiliation":[{"name":"University of Michigan  Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,4]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr2.11625"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000025644"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr2.11406"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0000000000000788"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.41752"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.7326\/M20-1594"},{"issue":"9","key":"e_1_2_6_8_1","article-title":"Time\u2010dependent evaluation of weighted cumulative glucocorticoid exposure and major adverse cardiovascular events in a cohort of veterans with rheumatoid arthritis Arthritis","volume":"75","author":"Wallace B","year":"2023","journal-title":"Rheumatol"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22312"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/1759720X17740075"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2005.07.003"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2020.102528"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2015.09.010"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2017-000536"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr2.11584"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.24382"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2021-220112"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2018.10.017"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar3260"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/cts.13649"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.24596"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2018.00039"},{"key":"e_1_2_6_23_1","unstructured":"QualityID#180: Rheumatoid Arthritis (RA): Glucocorticoid Management.CMS.gov.https:\/\/qpp.cms.gov\/docs\/QPP_quality_measure_specifications\/CQM-Measures\/2024_Measure_180_MIPSCQM.pdf. Accessed September 16 2024."},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-020-04660-y"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-022-02952-1"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar4201"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.22890"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr2.11406"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr2.11443"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204011"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-203843"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/s42358-024-00352-4"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0277566"},{"key":"e_1_2_6_34_1","unstructured":"Low income subsidy for prescription drug coverage.Centers for Medicare and Medicaid.https:\/\/www.cms.gov\/medicare\/enrollment-renewal\/part-d-plans\/low-income-subsidy."},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2017.12.010"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22542"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.24762"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kev239"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.24893"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2024.152535"}],"container-title":["ACR Open Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr2.70013","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T14:23:23Z","timestamp":1759415003000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/acr2.70013"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":39,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1002\/acr2.70013"],"URL":"https:\/\/doi.org\/10.1002\/acr2.70013","archive":["Portico"],"relation":{},"ISSN":["2578-5745","2578-5745"],"issn-type":[{"value":"2578-5745","type":"print"},{"value":"2578-5745","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3]]},"assertion":[{"value":"2024-10-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70013"}}