Socioeconomic status affects how quickly rheumatoid arthritis patients are treated

This study examined the association between socioeconomic status with clinical measures in rheumatoid arthritis patients.

Methotrexate (Rheumatrex, Trexall) is a disease-modifying antirheumatic drug (DMARD) and is currently the preferred initial treatment for patients with rheumatoid arthritis. Recent studies have reported that early treatment is key for patient well-being, as there is a “window of opportunity” when treatment is more likely to induce remission.

Potential causes of treatment delays include lengthy doctor wait time, long referral times to see specialists, lower socioeconomic status or living in rural areas. Given the importance of early treatment it is important to determine which factors can affect timing of DMARD use.

This study recruited 1209 rheumatoid arthritis patients from rheumatology clinics. Socioeconomic status was assessed based on education, occupation and income. Patients self-reported the timing of their symptom onset and the date they started DMARD treatment. The extent of patients’ disease activity (numbers of swollen and tender joints), joint damage and physical disability were also assessed by doctors.

Overall, 1159 of the patients had received DMARD treatment. On average patients with lower socioeconomic status waited 8.5 years after symptoms began before starting DMARD treatment. This was significantly longer than patients from middle (6.1 years) and upper (6.2 years) socioeconomic status.

Patients from low socioeconomic backgrounds also waited longer following diagnosis before starting treatment, an average of 4 years compared to 2.7 years in patients from upper socioeconomic status. Each year of delay in treatment was associated with significant increases in disease activity, joint damage and physical disability.

The authors concluded that patients from lower socioeconomic backgrounds experience longer delays in DMARD treatment. This was associated with increased disease activity, more joint damage and worse physical activity. They also highlight that strategies to reduce treatment delays in these patients are needed.