Abstract
BackgroundIn Brazil, socioeconomic differences in the incidence of rheumatoid arthritis (RA) have been demonstrated, which are important in the formulation of hypotheses regarding the association between environmental factors, lifestyle and the risk of disease development. This study examines how the socioeconomic condition of the patient with RA in Brazil, assessed according to social class, educational level, employment situation and use of caregivers, affects the times between the beginning of symptoms and diagnosis and the beginning of the use of disease-modifying antirheumatic drugs, as well as the presence of erosive disease and functional status.MethodsThis work is part of a multicentric study called REAL - Rheumatoid Arthritis in Real Life in Brazil, which is a prospective observational cohort study.ResultsAs described in the REAL study, we included a total of 1115 patients. It was noted that patients with an educational classification of up to second grade incomplete presented with erosion percentages above those with a higher grade complete. Patients with caregivers presented a higher percentage of erosion than patients without caregivers. We verified that patients from economic classes above B2 presented fewer occurrences of erosion than those from classes C2, D-E. We also analyzed the average time differences from the beginning of symptoms and diagnosis and the beginning of treatment, according to academic level, erosion and economic classification. Patients with first grade complete showed an HAQ-DI averages higher than those with second grade complete. The patients who had employment showed lower HAQ-DI averages than patients who were not employed. The patients with erosion showed an HAQ-DI value higher than those without erosion. Patients with caregivers showed an HAQ-DI average higher than that of without caregivers.ConclusionThis study showed that the therapeutic window of RA is not being reached, and therefore we should have a policy to expand and ensure access to public health for all patients, especially those with lower levels of education and income.Trial registrationThis study was approved by the National Commission of Ethics in Research.
Highlights
In Brazil, socioeconomic differences in the incidence of rheumatoid arthritis (RA) have been demonstrated, which are important in the formulation of hypotheses regarding the association between environmental factors, lifestyle and the risk of disease development
This study showed that the therapeutic window of RA is not being reached, and we should have a policy to expand and ensure access to public health for all patients, especially those with lower levels of education and income
Studies show that patients with a higher socioeconomic level have half the risk of RA development than patients with a lower level [2, 3], as well as a better outcome inclusively proved by a lower index in the Health Assessment Questionnaire-Disability Index (HAQ-DI) [4]
Summary
In Brazil, socioeconomic differences in the incidence of rheumatoid arthritis (RA) have been demonstrated, which are important in the formulation of hypotheses regarding the association between environmental factors, lifestyle and the risk of disease development. Socioeconomic differences in the incidence of RA, which are important in the formulation of hypotheses regarding the association between environmental factors, lifestyle and the risk of disease development, have been demonstrated. A better educational level and nonmanual work were associated with a lower risk of RA development [2]. Such socioeconomic differences are important from the perspective of public health. It is estimated that 20–70% of patients who are employed at the beginning of an RA diagnosis are unable to continue their work activities 7–10 years into the evolution of the disease, which can have negative consequences, including a reduction in social activities, quality of life and socioeconomic conditions [5]
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