Sociodemographic factors as determinants of disease, disability and quality of life trajectories in early rheumatoid arthritis: A multi‐ethnic inception cohort study

Abstract

Objective: This study aims to describe the association between sociodemographic factors and trajectories of disease, disability and health-related quality of life (HRQoL) in early rheumatoid arthritis (ERA).Methods: Data were collected prospectively over 3 years in the Singapore Early Arthritis Cohort study. Trajectories were modeled using multi-trajectory groupbased trajectory modeling (GBTM) and determinants of trajectory membership were identified using multinomial logistic regression.Results: Two hundred and thirteen patients were included: 58.2% Chinese, 16.4% Malay, 21.6% Indian, mean (SD) age 51.3 (12.6) years and symptom duration 21.8 (15.3) weeks. In the multi-trajectory analysis, three groups of disease trajectories and corresponding disability and HRQoL trajectories were identified: group 1 (moderate disease rapid response, 49.9%), group 2 (high disease rapid response, 31.1%) and group 3 (high disease slow response, 19.1%). Malay patients had higher relative risk ratio (RRR) of being in trajectory groups 2 and 3 compared to group 1 (RRR = 2.30, 95% CI 1.05-3.98 and RRR = 4.02, 95% CI 1.45-6.43, respectively) while patients with tertiary education had lower relative risk (RRR = 0.56, 95% CI 0.45-0.89 and RRR = 0.33, (95% CI 0.14-0.83, respectively). In the analysis of individual outcomes, ethnicity, education level and body mass index were determinants of the heterogeneous disease activity trajectories. Gender and education level were determinants of the disability trajectories. Only gender was a determinant of the HRQoL trajectories. Further, 96.2% of the patients were treated with conventional synthetic diseasemodifying antirheumatic drugs. Conclusion: Disparities in sociodemographic factors should be taken into consideration in formulating treatment strategies in ERA. K E Y W O R D S clinical outcome, disability, epidemiology, quality of life, rheumatoid arthritis S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Zou Y, Cheung PP, Teoh LK, Chen C, Lahiri M. Sociodemographic factors as determinants of disease, disability and quality of life trajectories in early rheumatoid arthritis: A multi-ethnic inception cohort study. Int J Rheum Dis. 2020;23:55-64. https ://doi.

Association between social deprivation and disease activity in rheumatoid arthritis: a systematic literature review

“…With regard to country of origin from where the study population was drawn, 7 were from the UK,1–3 15–18 10 from the rest of Europe (3 the Netherlands, 3 Sweden, 1 Norway, 1 Germany, 1 Denmark),4 19–25 6 from USA and Canada,26–31 4 from South America (2 Chile, 1 Mexico, 1 Peru)32–35 and 3 from Asia (1 India, 1 China, 1 Singapore) 36–38. One study included multinational data 39.…”

“…The majority of articles included educational achievement in their definition of SES, either alone or in combination with other factors. Educational attainment alone was used as a proxy for SES in eight (27%) of the included articles,4 23–25 33 38–40 while a further eight combined education with factors including employment status, occupation, income, race and area of residence 21 22 26–28 31 36 37. Finally, one article categorised SES according to the area of the city in which patients were resident,20 and another article used type of occupation 19…”

“…Most articles reported a combination of DAS, the most common being the DAS28 (22 of 30 articles, 73%), usually erythrocyte sedimentation rate (ESR) based. Health Assessment Questionnaire scores (HAQ) were also commonly described (24 of 30 articles, 80%),1–4 15–17 19 20 23 25–35 37 38 40 usually along with multiple other measures including DAS and/or a biochemical marker of inflammation such as ESR. Three articles reported only patient-reported outcomes (HAQ) 23 28 37.…”

Value of digital biomarkers in precision medicine: implications in cancer, autoimmune diseases, and COVID-19

“…Rheumatologists are still searching for reliable biomarkers or algorithms that may guide therapeutic choices [19,20]. The situation is more complicated, given the impact of additional variables (ethnic, geopolitical, and lifestyle) on the RA course and response to therapy [21,22]. The information conveyed by these variables can be leveraged at the clinical decision level.…”

Impact of socio-demographic and clinical characteristics on functional disability and health-related quality of life in patients with rheumatoid arthritis: a cross-sectional study from Palestine

“…Despite the importance of HRQoL and the degree of disability in patients with RA, no previous studies have been carried out to the best of our knowledge to determine HRQoL or disability in patients with RA in Palestine. However, some studies have been carried out worldwide, and few regional studies have been carried out [22][23][24][25][26][27][28][29][30][31][32][33].…”