A new study entitled “Association of Socioeconomic Status with Treatment Delays, Disease Activity, Joint Damage and Disability in Rheumatoid Arthritis” was published in Arthritis Care & Research by Emily Molina from University of Texas Health Science Center at San Antonio, TX and colleagues, and sought to understand the link between socioeconomic status and disease activity in rheumatoid arthritis.
Rheumatoid arthritis (RA) is an autoimmune inflammatory and debilitating disease that leads to joint damage and higher risk for cardiovascular disease. It affects approximately 1% of adults in western countries, mainly women. Many studies have shown that early treatment is essential for optimal management in Rheumatoid arthritis patients. There has been a growing idea in the early stages of RA of a “window of opportunity” for successful therapy and prevention of irreversible damage as well as in other autoimmune diseases. There are many factors contributing to late therapy of rheumatoid arthritis patients, including long clinician waiting times, having to go to a rheumatologist, and having lower socioeconomic status (SES). Thus a timely beginning of disease-modifying anti-rheumatic drug (DMARD) treatment of RA, and adequate follow up visits of RA patients is very important to ameliorate or delay the development of rheumatoid arthritis.
In this study, the research team evaluated the association between one’s socioeconomic status and disease activity, joint damage and disability, considering factors such as treatment delay and distance to the rheumatologist. The researchers enrolled 1,209 RA patients from rheumatology clinics where 1,159 had been treated with DMARD, evaluated the socioeconomic status by education, occupation and income and divided patients into tertiles. They examined disease activity, determined by 28-joint disease activity score using erythrocyte sedimentation rate (DAS28-ESR), joint damage analysis by hand radiographs through Sharp scores, and physical disability, determined by the Modified Health Assessment Questionnaire (MHAQ). They found that patients with lower SES started DMARD therapy 8.5 ± 10.2 years after the beginning of RA symptoms while patients in middle and upper SES tertiles started the treatment, respectively, 6.1 ± 7.9 years (P=0.002) and 6.1 ± 8.6 years (P=0.009), after the onset of RA symptoms. Importantly, the parameters DAS28ESR, Sharp score and MHAQ score increased, respectively 0.02 (P≤0.001), 1.33 (P≤0.001) and 0.01 (P≤0.001) per year of treatment delay.
The researchers concluded that lower socioeconomic status correlated with delay in DMARD initiation, and in addition, SES and DMARD treatment were associated independently with worse clinical interventions in RA. Therefore there is an urgent need to reduce treatment delay in patients with rheumatoid arthritis and low socioeconomic status.