Influence of social support, financial status, and lifestyle on the disparity between inflammation and disability in rheumatoid arthritis

Gwinnutt, James M., Norton, Sam, Hyrich, Kimme L., Lunt, Mark, Combe, Bernard, Rincheval, Nathalie, Ruyssen-Witrand, Adeline, Fautrel, Bruno, McWilliams, Daniel F., Walsh, David A., Nikiphorou, Elena, Kiely, Patrick D. W., Young, Adam, Chipping, Jacqueline R., MacGregor, Alex ORCID: and Verstappen, Suzanne M. M. (2023) Influence of social support, financial status, and lifestyle on the disparity between inflammation and disability in rheumatoid arthritis. Arthritis Care & Research, 75 (5). pp. 1026-1035. ISSN 2151-464X

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Objective: To investigate how social support, financial status, and lifestyle influence the development of excess disability in rheumatoid arthritis (RA). Methods: Data were obtained from the Étude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR) cohort study of people with RA. A previous analysis identified groups with similar inflammation trajectories but markedly different disability over 10 years; those in the higher disability trajectory groups were defined as having “excess disability.” Self-reported data regarding contextual factors (social support, financial situation, lifestyle) were obtained from participants, and they completed patient-reported outcome measures (pain, fatigue, anxiety, depression) at baseline. The direct effect of the contextual factors on excess disability and the effect mediated by patient-reported outcome measures were assessed using structural equation models. Findings were validated in 2 independent data sets (Norfolk Arthritis Register [NOAR], Early Rheumatoid Arthritis Network [ERAN]). Results: Of 538 included ESPOIR participants (mean age ± SD 48.3 ± 12.2 years; 79.2% women), 200 participants (37.2%) were in the excess disability group. Less social support (β = 0.17 [95% confidence interval (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 associated with excess disability group membership; smoking, alcohol consumption, and body mass index were not. Fatigue and depression mediated a small proportion of these effects. Similar results were seen in NOAR and ERAN. Conclusion: Greater emphasis is needed on the economic and social contexts of individuals with RA at presentation; these factors might influence disability over the following decade.

Item Type: Article
Additional Information: Funding information: Supported by Versus Arthritis (grant 21755), the NIHR Manchester Biomedical Research Centre, and the NIHR Nottingham Biomedical Research Centre. Dr. Gwinnutt's work was supported by a Medical Research Council Skills Development Fellowship. The Étude et Suivi des Polyarthrites Indifférenciées Récentes cohort was supported by MSD, INSERM, the French Society of Rheumatology, AbbVie, Pfizer, Lilly, Fresenius, and Galapagos. The Early Rheumatoid Arthritis Network cohort was supported by Wyeth Pharmaceuticals and the UK Healthcare Commission.
Depositing User: LivePure Connector
Date Deposited: 11 May 2023 14:30
Last Modified: 11 May 2023 14:30
DOI: 10.1002/acr.24996


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