AB1607 TREATMENT OUTCOME OF RHEUMATOID ARTHRITIS IN RURAL AND URBAN POPULATION; A COMPARATIVE STUDY FROM SOUTH INDIA

Abstract

BackgroundAdvances in rheumatology have made the once-disfiguring rheumatoid arthritis (RA) a controllable disease. However, differences in health care delivery exist across the rural and urban populations in South India. Hence disease characteristics may be different across the two groups of patients.[1,2]Herein, we compare the disease characteristics of RA across rural and urban populations based in the state of Kerala in South India.ObjectivesThe primary objective was to compare the disease characteristics of RA in rural and urban rheumatology centres in South India.MethodsA retrospective study of patients attending rural and urban clinics of our Institute was conducted. Consecutive 100 patients who attended the clinics from April to October 2022 and who satisfied the ACR/EULAR 2010 RA criteria were selected for the study in each group. Baseline Demographics were collected, and disease activity was measured using the CDAI score. Extraarticular manifestations and comorbidities associated with RA were also considered. Treatment response was assessed at the end of 6 months.ResultsThe mean age of patients was 51 years(± 12SD) and 55 years(±12SD) in urban and rural groups, respectively. Disease activity at baseline and six months was shown in Figure 1. 28% of the rural patients required triple DMARDs for disease control against 14% in the urban group (p-value 0.02). Remission at six months was attained in 47% of the urban population against 30% of the rural population (p-value 0.05). Non-alcoholic Fatty liver disease was more prevalent in the rural population (9%) than the urban population (2%)(p-value 0.05). DMARD-induced elevation of liver enzymes occurred in 15% of patients in the rural group compared to 5% of patients in the urban group(Pvalue-0.03). Even though the prevalence of uncontrolled T2DM and osteoarthritis was more in the rural population, the difference between the two groups was not statistically significant. Similarly, the use of biologicals was more in rural (8%) compared to urban (4%) without any statistical significance.ConclusionWe observed that baseline disease characteristics and disease activity were identical across both groups. At six months, CDAI and CRP were significantly higher in the rural than urban group suggesting that response to optimal DMARD treatment was better in the urban group than in the rural group. Triple DMARD use was also significantly higher in the rural compared to the urban group. This shows that despite the advances in rheumatology, there are still unmet needs regarding awareness and access to adequate treatment in rural society.