What role do socioeconomic and clinical factors play in disease activity states in rheumatoid arthritis? Data from a large UK early inflammatory arthritis audit
Background Persistently active rheumatoid arthritis (pactiveRA) may be due to the interplay between biological and non-biological factors. The role of socioeconomic factors remains unclear.Objectives To explore which biological and non-biological factors associate with pactiveRA.Methods Adults with...
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BMJ Publishing Group
2024-09-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/10/3/e004180.full |
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| author | Heidi Lempp Maya H Buch Sam Norton Andrew Cope Elena Nikiphorou Mrinalini Dey James Galloway Maryam Adas |
| author_facet | Heidi Lempp Maya H Buch Sam Norton Andrew Cope Elena Nikiphorou Mrinalini Dey James Galloway Maryam Adas |
| author_sort | Heidi Lempp |
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| description | Background Persistently active rheumatoid arthritis (pactiveRA) may be due to the interplay between biological and non-biological factors. The role of socioeconomic factors remains unclear.Objectives To explore which biological and non-biological factors associate with pactiveRA.Methods Adults with early RA in the National Early Inflammatory Arthritis Audit, recruited from May 2018 to October 2022, were included if having pactiveRA or persistently low RA (plowRA). The pactiveRA was defined as three consecutive Disease Activity Score-28 joints (DAS28) of >3.2 at baseline, 3 and 12 months. The plowRA was defined as DAS28 ≤3.2 at 3 and 12 months. Stepwise forward logistic regression was used to explore associations with pactiveRA (outcome). Age and gender were included a priori, with socioeconomic factors and comorbidities as exposure variables.Results 682 patients with pactiveRA and 1026 plowRA were included. Compared with plowRA, patients with pactiveRA were younger (58, IQR: 49–67) versus (62, IQR: 52–72), and included more women (69% vs 59%). The pactiveRA was associated with worse scores in patient-reported outcomes at baseline, and anxiety and depression screens. Overall, there was clear social patterning in pactiveRA, with age-by-gender interaction. Logistic regression indicated age, gender, social deprivation and previous or current smoking, were independently associated with pactiveRA, after controlling for disease severity markers (seropositivity). Depression, lung disease, gastric ulcers and baseline corticosteroid use, were also associated with pactiveRA (p<0.05 for all).Conclusion Socioeconomic factors and deprivation were associated with pactiveRA, independent of clinical and disease characteristics. Identifying ‘adverse’ socioeconomic drivers of pactiveRA can help tailor interventions according to individual need. |
| format | Article |
| id | doaj-art-a47526be8ab84ee2a7dadbd72815e15d |
| institution | OA Journals |
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| language | English |
| publishDate | 2024-09-01 |
| publisher | BMJ Publishing Group |
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| series | RMD Open |
| spelling | doaj-art-a47526be8ab84ee2a7dadbd72815e15d2025-08-20T01:55:46ZengBMJ Publishing GroupRMD Open2056-59332024-09-0110310.1136/rmdopen-2024-004180What role do socioeconomic and clinical factors play in disease activity states in rheumatoid arthritis? Data from a large UK early inflammatory arthritis auditHeidi Lempp0Maya H Buch1Sam Norton2Andrew Cope3Elena Nikiphorou4Mrinalini Dey5James Galloway6Maryam Adas7Centre for Rheumatic Diseases, King`s College London Faculty of Life Sciences & Medicine, London, UKCentre for Musculoskeletal Research, University of Manchester, Manchester, UKHealth Psychology, King`s College London Department of Psychology, London, UKCentre for Rheumatic Diseases, King`s College London Faculty of Life Sciences & Medicine, London, UKSchool of Immunology and Microbial Sciences, London, UKCentre for Rheumatic Diseases, King`s College London Faculty of Life Sciences & Medicine, London, UKKing`s College London, London, UKKing`s College London, London, UKBackground Persistently active rheumatoid arthritis (pactiveRA) may be due to the interplay between biological and non-biological factors. The role of socioeconomic factors remains unclear.Objectives To explore which biological and non-biological factors associate with pactiveRA.Methods Adults with early RA in the National Early Inflammatory Arthritis Audit, recruited from May 2018 to October 2022, were included if having pactiveRA or persistently low RA (plowRA). The pactiveRA was defined as three consecutive Disease Activity Score-28 joints (DAS28) of >3.2 at baseline, 3 and 12 months. The plowRA was defined as DAS28 ≤3.2 at 3 and 12 months. Stepwise forward logistic regression was used to explore associations with pactiveRA (outcome). Age and gender were included a priori, with socioeconomic factors and comorbidities as exposure variables.Results 682 patients with pactiveRA and 1026 plowRA were included. Compared with plowRA, patients with pactiveRA were younger (58, IQR: 49–67) versus (62, IQR: 52–72), and included more women (69% vs 59%). The pactiveRA was associated with worse scores in patient-reported outcomes at baseline, and anxiety and depression screens. Overall, there was clear social patterning in pactiveRA, with age-by-gender interaction. Logistic regression indicated age, gender, social deprivation and previous or current smoking, were independently associated with pactiveRA, after controlling for disease severity markers (seropositivity). Depression, lung disease, gastric ulcers and baseline corticosteroid use, were also associated with pactiveRA (p<0.05 for all).Conclusion Socioeconomic factors and deprivation were associated with pactiveRA, independent of clinical and disease characteristics. Identifying ‘adverse’ socioeconomic drivers of pactiveRA can help tailor interventions according to individual need.https://rmdopen.bmj.com/content/10/3/e004180.full |
| spellingShingle | Heidi Lempp Maya H Buch Sam Norton Andrew Cope Elena Nikiphorou Mrinalini Dey James Galloway Maryam Adas What role do socioeconomic and clinical factors play in disease activity states in rheumatoid arthritis? Data from a large UK early inflammatory arthritis audit RMD Open |
| title | What role do socioeconomic and clinical factors play in disease activity states in rheumatoid arthritis? Data from a large UK early inflammatory arthritis audit |
| title_full | What role do socioeconomic and clinical factors play in disease activity states in rheumatoid arthritis? Data from a large UK early inflammatory arthritis audit |
| title_fullStr | What role do socioeconomic and clinical factors play in disease activity states in rheumatoid arthritis? Data from a large UK early inflammatory arthritis audit |
| title_full_unstemmed | What role do socioeconomic and clinical factors play in disease activity states in rheumatoid arthritis? Data from a large UK early inflammatory arthritis audit |
| title_short | What role do socioeconomic and clinical factors play in disease activity states in rheumatoid arthritis? Data from a large UK early inflammatory arthritis audit |
| title_sort | what role do socioeconomic and clinical factors play in disease activity states in rheumatoid arthritis data from a large uk early inflammatory arthritis audit |
| url | https://rmdopen.bmj.com/content/10/3/e004180.full |
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