A recent study found that socioeconomic factors and social deprivation were independently associated with persistently active rheumatoid arthritis, even after controlling for clinical and disease characteristics.
In the study, published in RMD Open, investigators from King's College London analyzed data of 1,708 adult patients with early rheumatoid arthritis enrolled in the National Early Inflammatory Arthritis Audit (NEIAA) in England between May 2018 and October 2022. The patients were classified as having persistently active rheumatoid arthritis if they had Disease Activity Score–28 joints (DAS28) > 3.2 at baseline, 3 months, and 12 months, or persistently low rheumatoid arthritis if they had DAS28 ≤ 3.2 at 3 and 12 months.
The investigators discovered that 39.9% (n = 682) of the patients had persistently active rheumatoid arthritis, whereas 60.1% (n = 1,026) of the patients had persistently low rheumatoid arthritis. The patients who had persistently active rheumatoid arthritis were younger (median age = 58 vs 62 years) and more likely to be female (69.1% vs 59.2%) compared with those who had persistently low rheumatoid arthritis.
Logistic regression analysis showed persistently active rheumatoid arthritis was associated with:
- Younger age (odds ratio [OR] = 0.99, 95% confidence interval [CI] = 0.98–0.99)
- Female gender (OR = 1.40, 95% CI = 1.13–1.73)
- Ever-smoking status (OR = 1.40, 95% CI = 1.11–1.75)
- Greater social deprivation (OR = 0.91, 95% CI = 0.88–0.94 for less deprivation)
- Longer symptom duration (OR = 1.17, 95% CI = 1.07–1.28)
- Higher comorbidity burden (OR = 1.36, 95% CI = 1.20–1.54)
- Depression (OR = 2.22, 95% CI = 1.53–3.21)
- Lung disease (OR = 1.62, 95% CI = 1.20–2.18)
- Stomach ulcers (OR = 2.26, 95% CI = 1.40–3.65)
The investigators used stepwise forward logistic regression models to explore the associations between persistently active rheumatoid arthritis and socioeconomic factors, clinical variables, and treatment strategies. Age and gender were included a priori, with socioeconomic factors and comorbidities as exposure variables. Socioeconomic deprivation was measured using the Index of Multiple Deprivation, an area-level indicator linked to postal codes. Comorbidities were assessed using the Rheumatic Disease Comorbidity Index.
Margins plots revealed that the association between social deprivation and persistently active rheumatoid arthritis was more pronounced in women compared with men, particularly at older ages. Among those older than 60 years, there was a greater separation in the likelihood of persistently active rheumatoid arthritis, with increasing deprivation associated with more active disease in women compared with men.
The investigators noted that depression, which is known to be socially patterned, was significantly associated with persistently active rheumatoid arthritis. They suggested that addressing comorbidities like depression at an early stage might help minimize the risk of persistently active disease.
Study limitations included a large amount of missing data for patient-reported outcomes and potential selection bias caused by the requirement of disease activity to be recorded at three defined time points.
The investigators concluded that identifying adverse socioeconomic drivers of persistently active rheumatoid arthritis could help risk stratify patients and tailor interventions according to individual needs. They emphasized the importance of adopting management strategies that target both biological and nonbiological factors contributing to persistently active disease.
This study built on previous research demonstrating associations between socioeconomic status and rheumatoid arthritis outcomes, highlighting the continued relevance of these factors in the current treatment era. The findings underscored the need for a holistic approach to rheumatoid arthritis management that addresses both clinical and socioeconomic determinants of disease activity.
The authors declared having no competing interests.