Variation Among Rheumatologists in the Use of Prednisone and Second-line Agents for the Treatment of Rheumatoid Arthritis

Objective: To test for and estimate variation among rheumatologists in their prescribing of prednisone and second-line agents for the treatment of rheumatoid arthritis (RA), after taking into account the characteristics of their patients.

Methods: Multiple logistic regression incorporating random effects for rheumatologists, with adjustment for patient characteristics.

Results: Values for the likelihood-ratio statistic provided strong evidence of such variation. Random-effect variance estimates showed that the variation is of great magnitude.

Conclusion: Even after patient characteristics have been taken into account, the data show that the rheumatologist may strongly influence the use of prednisone and second-line agents by a patient.