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Poorer people suffer worst with rheumatoid arthritis

RA patients in low social groups have worse depression with poor function

Louise Prime

Thursday, 27 January 2011

People with rheumatoid arthritis (RA) are more likely to suffer from depression if they have low socioeconomic status, research has shown. They also tend to be more prone to depression at a given level of functional limitation than RA patients from higher socioeconomic groups, say researchers in Arthritis Care & Research.

Researchers in San Francisco compared the risk of depression in 466 rheumatoid arthritis patients attending a clinic in either an urban county public hospital (which serves the poor) or a tertiary care medical centre; they used clinic location as a proxy for socioeconomic status. They also examined data on participants’ physical health.

Overall, more than a third (37%) of patients scored at least 10 on the Patient Health Questionnaire-9 (PHQ-9) i.e. they had moderate to severe depression. Patients’ Health Assessment Questionnaire (HAQ) scores and the disease activity score (DAS28) revealed moderately high functional impairment and disease activity.

There were significant differences between depressed and non-depressed RA patients in terms of race, public vs. university hospital, disability and medications. These differences were not accounted for by age, sex, disease duration, steroid use and dose or biological therapies.

Patients who attended the county hospital clinic had significantly higher depression scores (PHQ of 7.3) than those at the university medical centre (PHQ-9 of 5.7).

As might be expected, there was a positive association between functional limitation and depression, but the authors also found that this was affected by socioeconomic status: “Mean depression scores rose more precipitously as functional limitation increased at the public-hospital rheumatology clinic,” they reported.

The authors say that rheumatoid arthritis patients with low socioeconomic status are disadvantaged in terms of both physical and mental health “such that a vulnerable population with functional limitations is at higher risk for depressive symptoms”.

They conclude: “For the same level of disability, patients with low socioeconomic status may be more likely to experience depression.

“Detection and documentation of the differing effects of disability on depression between patients of different socioeconomic status can help rheumatologists improve health outcomes by initiating appropriate and timely treatment for depression.”

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