Rheumatoid Arthritis Is Worse In Poorer Countries

People in less affluent countries appear to suffer from more severe rheumatoid arthritis (RA) than people in wealthy countries, suggests research published ahead of print in the Annals of the Rheumatic Diseases.


A study of 25 mostly European countries showed that the clinical status of patients with RA was inversely correlated with each country's gross domestic product (GDP).


Dr Tuulikki Sokka from Jyvaskyla Central Hospital in Finland and other members of the Quantitative Standard Monitoring of Patients with RA (QUEST-RA) programme, studied clinical and questionnaire data from 6,004 patients who were seen in usual care at 71 rheumatology clinics in 25 countries, including 18 European countries, between 2005 and April 2008.


All patients were assessed according to a standard protocol to evaluate RA, including a formal medical examination, laboratory measures, and a patient self-report health assessment questionnaire. Data were also gathered on use of disease-modifying anti-rheumatic drugs. Patient data were analysed together with the gross domestic product (GDP) for each country.


They found that patients in low GDP countries had statistically significantly higher disease activity levels in all disease activity measures, despite the fact that all patients had access to a rheumatologist and had received drugs to modify their condition.


Disparities in health, including high mortality rates, are recognised to be associated with low socioeconomic status in many specific diseases in many countries. The burden of chronic diseases is recognised as an important neglected global issue, say the authors, and is heaviest in low and middle-income countries.


This study, said the authors, indicates a need for more medical research in low GDP countries, as most previously published data have been derived from western European and North American nations.


The authors conclude "Public health efforts would appear potentially to be as important as the introduction of new therapies to treat RA.


"The burden of arthritis appears substantially greater in 'low GDP' than in 'high GDP' countries. These findings may alert healthcare professionals and designers of health policy towards improving the clinical status of patients with RA in all countries."


"Disparities in rheumatoid arthritis disease activity according to gross domestic product in 25 countries in the QUEST-RA database."

Ann Rheum Dis 2009; doi 10.1136/ard.2009.109983


Source
Annals of the Rheumatic Diseases