Association Between Socioeconomic Status (SES), Learned Helplessness (LH), and Prognosis in Patients with Inflammatory Polyarthritis

Abstract

Objectives. To investigate the relationship between SES, LH, and disease outcome in patients with recent-onset inflammatory polyarthritis (IP), the broader group of conditions of which RA is the major constituent .Methods. SES was measured using the Index of Multiple Deprivation 2007 for 553 patients. These patients were also measured by the Rheumatology Attitudes Index for their LH. SES and LH were investigated as predictors of disease outcome (functional disability [Health Assessment Questionnaire (HAQ)] and disease activity [Disease Activity Score in 28 joints]) in a regression analysis, adjusted for age, sex, and symptom duration. The role of LH in the relationship between SES and disease outcome was then investigated. Results. Compared to patients of the highest SES, those of the lowest SES had a worse outcome (median difference in HAQ score 0.42; 95% confidence interval [95% CI] 0.08, 0.75). Compared to patients with normal LH, patients with low LH had a better outcome and patients with high LH had a worse outcome (median difference in HAQ score 1.12; 95% CI 0.82, 1.41). There was a likelihood that LH mediated the association between SES and disease outcome (P 0.04)?. Conclusion. LH is associated with cross-sectional disease outcome in patients with IP, and appears to mediate the relationship between SES and disease outcome. As LH is potentially modifiable, these findings have potential clinical implications.