Higher education is associated with a better rheumatoid arthritis outcome concerning for pain and function but not disease activity: results from the EIRA cohort and Swedish rheumatology register

Abstract

IntroductionWhether low socioeconomic status (SES) is associated with worse rheumatoid arthritis (RA) outcomes in countries with general tax-financed healthcare systems (such as Sweden) remains to be elucidated. Our aim was to investigate the influence of educational background (achieving university/college degree (high) or not (low)) on the outcomes of early RA, in terms of disease activity (DAS28), pain (VAS-pain), and functional impairment (HAQ).MethodsWe evaluated DMARD-naïve RA patients recruited in the Epidemiological Investigation of RA (EIRA) study with outcomes followed in the Swedish Rheumatology Quality (SRQ) register (N = 3021). Outcomes were categorized in three ways: 1) scores equal to/above median vs. below median; 2) DAS28-based low disease activity, good response, remission; 3) scores decreased over the median vs. less than median. Associations between educational background and outcomes were calculated by modified Poisson regressions, at diagnosis and at each of the three standard (3, 6, 12 months) follow-up visits.ResultsPatients with different educational background had similar symptom durations (195 days) and anti-rheumatic therapies at baseline, and comparable treatment patterns during follow-up. Patients with a high education level had significantly less pain and less functional disability at baseline and throughout the whole follow-up period (VAS-pain: baseline: 49 (28-67) vs. 53 (33-71), p <0.0001; 1-year visit: RR = 0.81 (95 % CI 0.73-0.90). HAQ: baseline: 0.88 (0.50-1.38) vs. 1.00 (0.63-1.50), p = 0.001; 1-year visit: 0.84 (0.77-0.92)). They also had greater chances to achieve pain remission (VAS-pain ≤20) after one year (1.17 (1.07-1.28)). Adjustments for smoking and BMI altered the results only marginally. Educational background did not influence DAS28-based outcomes.ConclusionIn Sweden, with tax-financed, generally accessible healthcare system, RA patients with a high education level experienced less pain and less functional disability. Further, these patients achieved pain remission more often during the first year receiving standard care. Importantly, education background affected neither time to referral to rheumatologists, disease activity nor anti-rheumatic treatments.

Association of Comorbidities in Spondyloarthritis With Poor Function, Work Disability, and Quality of Life: Results From the Assessment of SpondyloArthritis International Society Comorbidities in Spondyloarthritis Study

“…The link between higher education and lower functional disability and higher rates of employment is interesting. These associations are well‐established in RA , but less so in SpA. Our results suggest that the relationship between comorbidities and the outcomes is independent of the effect of education, and that a higher education is associated with lower functional disability and a higher rate of employment.…”

Factors influencing remission in rheumatoid arthritis patients: results from Karnataka rheumatoid arthritis comorbidity (KRAC) study

“…Thus, the present study concludes educational level of the patients as one of the influencing factors of treatment outcome. Contrary to this finding, a Swedish cohort study has reported that educational background does not influence DAS28‐based outcomes in RA patients, although it had been demonstrated that patients with higher education level experienced less pain and reduced functional disability . Although family income has direct relationship with education, these confounding factors did not influence the treatment protocol.…”

Arthritis and Health Related Quality of Life in Adult Outpatients in Trinidad: A Cross Sectional Study

“…It is important to note that in countries with generally easily accessible healthcare systems, educational background does not directly impact disease activity but patients with a higher educational level may have slightly less pain and less functional disability. This was explored in a study conducted in Sweden (22).…”