{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T19:58:19Z","timestamp":1782158299752,"version":"3.54.5"},"reference-count":29,"publisher":"The Journal of Rheumatology","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>To evaluate the effect of access to and distance from rheumatology care on the use of disease-modifying antirheumatic drugs (DMARD) in US veterans with inflammatory arthritis (IA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>Provider encounters and DMARD dispensations for IA (rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis) were evaluated in national Veterans Affairs (VA) datasets between January 1, 2015, and December 31, 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>Among 12,589 veterans with IA, 23.5% saw a rheumatology provider. In the general IA population, 25.3% and 13.6% of veterans were exposed to a synthetic DMARD (sDMARD) and biologic DMARD (bDMARD), respectively. DMARD exposure was 2.6- to 3.4-fold higher in the subpopulation using rheumatology providers, compared to the general IA population. The distance between veterans\u2019 homes and the closest VA rheumatology site was &lt; 40 miles (Near) for 55.9%, 40\u201399 miles (Intermediate) for 31.7%, and \u2265 100 miles (Far) for 12.4%. Veterans in the Intermediate and Far groups were less likely to see a rheumatology provider than veterans in the Near group (RR = 0.72 and RR = 0.49, respectively). Exposure to bDMARD was 34% less frequent in the Far group than the Near group. In the subpopulation who used rheumatology care, the bDMARD exposure discrepancy did not persist between distance groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion.<\/jats:title><jats:p>Use of rheumatology care and DMARD was low for veterans with IA. DMARD exposure was strongly associated with rheumatology care use. Veterans in the general IA population living far from rheumatology sites accessed rheumatology care and bDMARD less frequently than veterans living close to rheumatology sites.<\/jats:p><\/jats:sec>","DOI":"10.3899\/jrheum.170554","type":"journal-article","created":{"date-parts":[[2017,11,16]],"date-time":"2017-11-16T01:25:38Z","timestamp":1510795538000},"page":"430-436","source":"Crossref","is-referenced-by-count":16,"title":["Use of Disease-modifying Antirheumatic Drugs for Inflammatory Arthritis in US Veterans: Effect of Specialty Care and Geographic Distance"],"prefix":"10.3899","volume":"45","author":[{"given":"Jessica A.","family":"Walsh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaobo","family":"Pei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Burningham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gopi","family":"Penmetsa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant W.","family":"Cannon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel O.","family":"Clegg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian C.","family":"Sauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2262","published-online":{"date-parts":[[2017,11,15]]},"reference":[{"key":"2018112909375703000_45.3.430.1","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1002\/acr.22856","article-title":"Increasing public health burden of arthritis and other rheumatic conditions and comorbidity: results from a statewide health surveillance system, 2007\u20132012","volume":"68","author":"Han","year":"2016","journal-title":"Arthritis Care Res"},{"key":"2018112909375703000_45.3.430.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-0361.2006.00022.x"},{"key":"2018112909375703000_45.3.430.3","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1111\/jrh.12070","article-title":"Geographic access and use of infectious diseases specialty and general primary care services by veterans with HIV infection: implications for telehealth and shared care programs","volume":"30","author":"Ohl","year":"2014","journal-title":"J Rural Health"},{"key":"2018112909375703000_45.3.430.4","unstructured":"Spoont M Greer N Su J . 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