Direct and indirect costs associated with the onset of seropositive rheumatoid arthritis

Objective, To examine the direct and indirect costs of rheumatoid arthritis (RA) during the first year of disease. Methods. As part of a longitudinal observational study, 150 patients with s eropositive RA of 5.9 +/- 2.9 mo duration were recruited through the Wester n Consortium of Practicing Rheumatologists. Subjects completed questionnair es about health care services and resources utilized and about the number o f days of usual activity lost as a result of RA during the 6 month period p rior to enrollment. Results, Study participants had active RA as evidenced by mean tender and s wollen joint counts of 24.9 +/- 13.5 and 20.6 +/- 11.6, respectively, and m oderate functional impairment reflected by a mean Health Assessment Questio nnaire (HAQ) score of 1.24 +/- 0.7. The average total direct cost of RA was $200/month. Health care visits, medications, and radiographs accounted for 78% of the total direct cost, while expenditures for hospitalizations acco unted for only 3.5% of the total. The average number of days of usual activ ity lost per month because of RA was 3.8 +/- 7.7, translating into an avera ge indirect cost of $281/month. Of the 95 subjects who were gainfully emplo yed prior to disease onset, 12 were disabled and 5 were on sick leave as a result of RA, corresponding to a work disability rate of 18%. Work disabled subjects reported significantly lower total household incomes and higher H AQ disability and global disease activity scores than subjects who continue d working. Conclusion. In this group of patients with seropositive RA substantial cost s, both direct and indirect, were incurred during the first year of disease .