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Disease activity and health status in rheumatoid arthritis: a case-control comparison between Norway and Lithuania

J Dadoniene¹, T Uhlig², S Stropuviene¹, A Venalis¹, A Boonen³ and T K Kvien²

¹ Institute of Experimental and Clinical Medicine, Vilnius University, Vilnius, Lithuania
² Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
³ Department of Rheumatology, University Hospital Maastricht, the Netherlands

Correspondence to:
Correspondence to:
Professor J Dadoniene, Institute of Experimental and Clinical Medicine, Vilnius University, Zygimantu 9, Vilnius, LT-2600, Lithuania;
dadon{at}ktl.mii.lt

Objective: To compare disease characteristics and health status in patients with rheumatoid arthritis (RA) from two countries, Norway and Lithuania.

Methods: Patients were recruited from the RA registers in Vilnius (Lithuania) and Oslo (Norway). For each patient from Vilnius, a patient matched for age and sex from the Oslo register was selected. Sociodemographic characteristics, disease process, and health status were compared between the patient groups.

Results: 201 Lithuanian patients and 201 Norwegian patients were included. Mean (SD) age in both groups was 55.9 (10.0) years, and 83% were women. Patients from Lithuania were less often employed (27% v 42%; p=0.001), had higher disease activity expressed by the disease activity score (DAS28; mean (SD) 5.3 (1.0) v 4.4 (1.4); p<0.001), had worse physical function by the modified Health Assessment Questionnaire (MHAQ; mean (SD) 2.3 (0.8) v 1.6 (0.5); p<0.001), had more often comorbidity (73% v 53%; p<0.001) and they reported worse general health measured by Short Form-36 Health Survey (SF-36; mean (SD) 23.2 (13.5) v 44.5 (21.3); p<0.001). The proportions of patients who had used disease modifying drugs were similar, but the pattern of use differed.

Conclusion: Important differences in employment, disease activity, physical function, and self reported health status were observed in patients with RA from two northern European countries. Socioeconomic inequalities, differences in disease management, and access to specialised health care, as well as methodological issues regarding instruments and data collection are likely explanations. These data support the view that management of RA should be adapted to country-specific needs.

Keywords: rheumatoid arthritis; epidemiology; cross country comparisons; health status

Abbreviations: DAS28, disease activity score; DMARD, disease modifying antirheumatic drug; MHAQ, modified Health Assessment Questionnaire; RA, rheumatoid arthritis; SF-36, Short Form-36 Health Survey

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