Less social support, lower financial status, and lower education level are all associated with excess disability in patients with rheumatoid arthritis (RA), according to results of an analysis published in Arthritis Care & Research.

Researchers sought to explore the ways in which social support, financial status, and lifestyle are associated with the development of excess disability in patients with RA. A secondary study objective was to examine the mediating effect of patient-reported outcome measures (PROMs: fatigue, pain, anxiety, and depression) on the relationship among these antecedent factors and excess disability in individuals with RA.

Data from the Étude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR) study (ClinicalTrials.gov identifier: NCT03666091) — a cohort study of individuals with inflammatory arthritis recruited from 14 centers across France between 2002 and 2005 — were evaluated.


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A prior analysis had identified groups with similar inflammation trajectories but noticeably different disability over 10 years. Those in the higher disability trajectory arms were defined as having “excess disability.” All of the participants self-reported information on contextual factors (ie, social support, financial situation, and lifestyle) and completed PROMs at baseline.

The study inclusion criteria for ESPOIR included (1) more than 2 swollen joints for between 6 weeks and 6 months; (2) a clinical diagnosis of RA, which was as certain as possible; (3) age between 18 and 70 years; and (4) no use of disease-modifying antirheumatic drugs or glucocorticoids for more than 2 weeks.

At baseline, all participants responded to several questions from the Evaluation de la Précarite et des Inégalites de santé dans les Centres d’Examens de Santé (EPICES) questionnaire, which included (1) whether participants felt they had someone on whom to rely for accommodation or financial assistance; (2) whether they were married or cohabiting, compared with being single, divorced, or widowed; and (3) whether they had seen their family in the prior 6 months. All participants also needed to report the number of individuals residing in the town or city where they lived (ie, <5000, 5000 to 20,000, 20,000 to 50,000, or >50,000).

At baseline, the financial situation of all participants was evaluated via questions in which they needed to self-report their monthly family income; their personal income; whether they were homeowners; whether they had been to a show or a cinema in the prior 6 months; and whether they had been on holiday in the past 6 months.

Among a total of 538 ESPOIR participants included in the study, 37.2% (n=200) of them were in the excess disability group. The mean age in the ESPOIR cohort was 48.3±12.2 years. Overall, 79.2% (n=426) of the participants were women. Findings from the analysis were validated within 2 independent datasets: Norfolk Arthritis Register (NOAR) and Early Rheumatoid Arthritis Network (ERAN).

Less social support (β, 0.17; 95% CI, 0.08-0.26), worse financial situation (β, 0.24; 95% CI, 0.14-0.34), less exercise (β, 0.17; 95% CI, 0.09-0.25), and less education (β, 0.15; 95% CI 0.06-0.23) were all significantly associated with membership in the excess disability group; however, alcohol consumption, smoking, and body mass index were not. The presence of depression and fatigue mediated a small percentage of these effects. Similar findings were observed in both NOAR and ERAN.

Limitations of the study should be noted. Any attempts to include all of the exposure variables within a single structural equation modeling approach were not successful because of problems with model convergence (due, perhaps, to limitations in statistical power). Future analyses with larger sample sizes should aim to combine all of the antecedent factors into single models, in order to separate out the individual effects.

The study authors conclude that social and economic factors play a pivotal role in “explaining the inflammation-disability gap evident in the long-term outcomes of people with RA, and these factors require greater prominence in RA management strategies and guidelines.”

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference                                                                                                                                      

Gwinnutt JM, Norton S, Hyrich KL, et al. The influence of social support, financial status and lifestyle on the disparity between inflammation and disability in rheumatoid arthritis. Arthritis Care Res. Published online August 4, 2022. doi:10.1002/acr.24996