Objective. US Hispanics with rheumatoid arthritis experience worse functional outcomes compared to whites. The determinants of disability, however, are not well established in large Hispanic cohorts. In the present report, we identified factors associated with disability in a cross-sectional design, and evaluated their individual contributions to disability over time. Methods. Two hundred fifty-one Hispanic subjects from a single center were evaluated. Disease activity, serologies, radiographs, treatments, irreversible articular damage (defined as subluxation, arthrodesis, fusion, or prosthesis), and joint replacement surgeries were recorded. Self-reported disability (Health Assessment Questionnaire disability index), patient pain by a visual analog scale, and depression assessments were collected. Cross-sectional factors associated with disability were identified, and their effects on future disability were evaluated in a subgroup of 114 patients assessed 6 months later. Results. Six parameters were independently related to disability cross-sectionally: pain was the strongest (P < 0.0001), followed by irreversible articular damage, disease activity, depression, age, and fibromyalgia (P < 0.03 for all). Baseline parameters predicting disability 6 months later included, in decreasing significance, irreversible articular damage (P ‫؍‬ 0.004), depression, disease activity, age, and pain (all P < 0.04). Conclusion. In cross-sectional analysis, self-reported pain had the strongest relationship with disability; however, factors such as irreversible articular damage, depression, and disease activity were more important in predicting future disability. Most of these factors are amenable to targeted interventions and should be addressed in an effort to improve functional outcomes.

Objective: Despite the high prevalence of depression among vulnerable Hispanics with rheumatoid arthritis (RA), many do not disclose it or seek treatment. This study explored patient perceptions of depression, its association with their primary disease, barriers to disclosure, reasons for low utilization of mental health care resources, and culturally acceptable intervention approaches. Methods: Semistructured interviews were conducted with 46 participants with RA. Depression was evaluated using Patient Health Questionnaire 9 (PHQ-9). Results: Thirty-three percent of participants were moderately depressed at the time of the interview, based on PHQ-9 score >10; 12 of 46 patients (26%) stated they were depressed regardless of PHQ-9 score. Depression was perceived as a long-term, severe problem leading to suicide. It was associated with weakness and character flaws, contributing to stigma and reduced likelihood of disclosure. Antidepressants were not acceptable; self-reliance and interventions incorporating interpersonal connections were preferred. Systems-related barriers to disclosure included lack of verbal screening, language barriers, limited clinic visit time, and lack of continuity of care, restricting trust with providers. Conclusion: Rectifying misconceptions, as well as providing education regarding the association between RA and depression, the continuum of symptoms, and the range of experiences incurred are needed to facilitate earlier recognition and reduce stigma. Use, duration, and goals of antidepressant therapy should be clarified. Providers should strive to establish trust and conduct in-person depression screening to facilitate disclosure. Interventions with an interpersonal component, such as support groups or patient navigators, were preferred. Themes emphasizing coping strategies, stress reduction, positive thinking, self-efficacy, and resiliency are likely to be most acceptable.

Results suggest that disease activity, depression, and pain are modifiable parameters with consistent, significant, independent, and additive contributions to HAQ DI changes across the disease trajectory in vulnerable Hispanic patients with RA. Their improvement over time, collectively or in isolation, may yield clinically measurable improvements in functional disability and reaffirms these parameters as actionable items in a patient-centered treat-to-target approach.

Background Structural damage has been associated with poor functional outcomes and disability in Rheumatoid Arthritis (RA). Hispanics with RA in the US display worse functional outcomes, despite similar disease control to Caucasians. However, the presence of structural articular damage and orthopedic surgeries performed in this subset remains unknown. Objectives To explore the prevalence of irreversible articular damage, orthopedic surgeries, joint replacements and their distribution in US Hispanics with RA. Methods Two hundred and ninety five subjects from a single center were evaluated. Demographics, serologies, radiographs, and treatments were recorded. Irreversible articular damage (IAD) was defined as presence of subluxation, arthrodesis, fusion, or prosthesis). Orthopedic surgeries in upper and lower extremities as well as joint replacement surgeries (JRS) were captured. Non-parametric Mann-Whitney U and Fisher’s exact tests compared continuous and categorical variables respectively. Results Patients are predominantly females with robustly seropositive, chronic, and well controlled RA. IAD was present in 35% of patients and was significantly higher on subjects treated with biologics (43% vs. 26%, p=0.002- table 1). Similarly, the majority of patients with IAD received biologics (65% vs. 39%, p=0.002). Orthopedic surgeries occurred in 39/295 (13%) of patients, or 39/102 (38%) of those with IAD. A higher proportion of subjects on biologics underwent surgery (19% vs. 8% on DMARDs, p=0.006). Concordantly, surgeries occurred predominantly in patients on biologics (69% vs. 31%, p=0.02). Most patients undergoing surgery, had 2 or more procedures (72% vs. 28%, p=0.0002). Overall, 39 subjects underwent 88 procedures; 66/88 (76%) occurred on the lower extremities, and 16/88 (18%) on the upper extremities. The majority were joint replacements (65/88 or 75%), most occurred on the lower extremities (89% vs. 11%), and tended to be more common in subjects on biologics. All (295)DMARDS (152)Biologics (143)p Disease Duration (yr)10±8.68.6±7.811.8±9.10.0004 DAS28-3v-ESR (M±SD)3.38±1.23.48±1.23.27±1.20.2 Prednisone-n (%)100/295 (34)50/152 (33)50/143 (35)0.7 n-DMARDs (M±SD)2.2±11.9±0.82.6±1<0.0001 Erosions, n (%)173/295 (59)83/152 (55)90/143 (63)0.15 IAD, n (%)102/295 (35)40/152 (26)62/143 (43)0.002 Joint Surgeries (JS), n (%)39/295 (13)12/152 (8)27/143 (19)0.006  n (%) with 1 JS11/39 (28)2/12 (17)9/27 (33)0.44  n (%) with ≥2 JS28/39 (72)10/12 (83)18/27 (67)0.44 JRS, n (%)33/295 (11)12/152 (8)21/143 (15)0.065  n (%) with 1 JRS11/33 (33)5/12 (42)6/21 (29)0.47  n (%) with ≥2 JRS22/33 (67)7/12 (58)15/21 (71)0.47 Joint surgeries, n883355  n (%)-upper extremity16/88 (18)5/33 (15)11/55 (20)0.8  n (%)-lower extremity66/88 (76)27/33 (82)39/55 (71)0.8  n - other (%)5/88 (6)1/33 (3)4/55 (7)0.42 n - joint replacements652639  n - upper extremity (%)7/65 (12)4/26 (15)3/39 (8)0.42  n - lower extremity (%)58/65 (89)22/26 (85)36/39 (92)0.42 Conclusions One third of US Hispanics experience irreversible articular damage, especially those ...