Socioeconomic deprivation and rheumatoid disease: What lessons for the health service?

Objective-To assess how socioeconomic deprivation influences the presentati on, treatment, and outcome of patients with rheumatoid arthritis (RA). Methods-Three year follow up of 869 consecutive patients with RA from nine hospital rheumatology clinics, with patients categorised by the Carstairs d eprivation score of their enumeration district of residence. Outcomes inclu ded Health Assessment Questionnaire (HAQ), joint and pain scores, grip stre ngth, functional grade, radiological evidence of bony erosions, and medical /surgical interventions. Results-Patients from more deprived enumeration districts presented with mo re severe disease as judged by the HAQ score and joint scores. An increase from the 5th to the 95th centile of the Carstairs distribution wats associa ted with an adds ratio of 1.87 (95% confidence interval (95% CT) 1.31 to 2. 66) for an above-median HAQ score and 1.77 (95% CI 1.23 to 2.54) for an abo ve-median joint score. Statistically non-significant deprivation trends wer e seen with erythrocyte sedimentation rate, pain score, and grip strength. By three years, despite no important differences in clinical management, so cioeconomic differentials had worsened or remained unchanged such that clea r deprivation trends were then seen in HAQ (p=0.002) and joint scores (p=0. 001), in grip strength (p=0.008), and in functional grade (p=0.003). The as sociation between deprivation and HAQ at three years was present after adju stment for age, sex, treatment centre, and HAQ at presentation (adjusted od ds ratio 1.74, 95% CI 1.1 to 2.74). Conclusions-Socioeconornic deprivation was associated with a worse clinical course of rheumatoid disease, and this effect was already apparent at pres entation, but not with systematic differentials in its treatment. This sugg ests that individual susceptibility and lifestyle factors contribute to soc ioeconomic differentials in its treatment. This suggests that individual su sceptibility and lifestyle factors contribute to socioeconomic differential s in outcome, an observation that has implications for clinical management.