CLINICAL AND EPIDEMIOLOGICAL RESEARCH

Extended report

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

T Sokka¹, H Kautiainen², T Pincus³, S Toloza⁴, G da Rocha Castelar Pinheiro⁵, J Lazovskis⁶, M L Hetland⁷, T Peets⁸, K Immonen⁹, J F Maillefert¹⁰, A A Drosos¹¹, R Alten¹², C Pohl¹², B Rojkovich¹³, B Bresnihan¹⁴, P Minnock¹⁵, M Cazzato¹⁶, S Bombardieri¹⁶, S Rexhepi¹⁷, M Rexhepi¹⁷, D Andersone¹⁸, S Stropuviene¹⁹, M Huisman²⁰, S Sierakowski²¹, D Karateev²², V Skakic²³, A Naranjo²⁴, E Baecklund²⁵, D Henrohn²⁵, F Gogus²⁶, H Badsha²⁷, A Mofti²⁸, P Taylor²⁹, C McClinton²⁹, Y Yazici³

¹ Jyväskylä Central Hospital, Jyväskylä; Medcare Oy, Äänekoski, Finland
² Unit of Family Practice, Jyväskylä Central Hospital, Jyväskylä, and ORTON, Rehabilitation Unit, Helsinki, Finland
³ NYU Hospital for Joint Diseases, New York, NY, USA
⁴ Hospital San Juan Bautista, Catamarca, Argentina
⁵ Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
⁶ Riverside Professional Center, Sydney, NS, Canada
⁷ Copenhagen Univ Hospital at Hvidovre, Hvidovre, Denmark
⁸ East-Tallinn Central Hospital, Tallinn, Estonia
⁹ North Karelia Central Hospital, Joensuu, Finland
¹⁰ Dijon University Hospital, University of Burgundy and INSERM U887, Dijon, France
¹¹ University of Ioannina, Ioannina, Greece
¹² Schlosspark-Klinik, Berlin, Germany
¹³ Polyclinic of the Hospitaller Brothers of St. John of God in Budapest, Budapest, Hungary
¹⁴ St. Vincent University Hospital, Dublin, Ireland
¹⁵ Our Lady's Hospice, Dublin, Ireland
¹⁶ Santa Chiara Hospital, Pisa, Italy
¹⁷ Rheumatology Department, Pristine, Kosovo
¹⁸ Pauls Stradina Clinical University Hospital, Riga, Latvia
¹⁹ Institute of Experimental and Clinical Medicine at Vilnius University, Vilnius, Lithuania
²⁰ Sint Franciscus Gasthuis Hospital, Rotterdam, Netherlands
²¹ Medical University in Bialystok, Bialystok, Poland
²² Early Arthritis Department, Institute of Rheumatology of Russian Academy of Medical Sciences, Moscow, Russia
²³ Rheumatology Institut, Niska Banja, Serbia
²⁴ Hospital de Gran Canaria Dr. Negrin, Las Palmas, Spain
²⁵ Uppsala University Hospital, Uppsala, Sweden
²⁶ Gazi University Medical Faculty, Ankara, Turkey
²⁷ Dubai Bone and Joint Center, Dubai, United Arab Emirates
²⁸ American Hospital Dubai, Dubai, United Arab Emirates
²⁹ University Medical Faculty, Charing Cross Hospital, London, UK

^{Correspondence to} Dr T Sokka, Arkisto/Tutkijat, Jyväskylä Central Hospital, 40620 Jyväskylä, Finland; tuulikki.sokka{at}ksshp.fi

Objective: To analyse associations between the clinical status of patients with rheumatoid arthritis (RA) and the gross domestic product (GDP) of their resident country.

Methods: The Quantitative Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST–RA) cohort includes clinical and questionnaire data from 6004 patients who were seen in usual care at 70 rheumatology clinics in 25 countries as of April 2008, including 18 European countries. Demographic variables, clinical characteristics, RA disease activity measures, including the disease activity score in 28 joints (DAS28), and treatment-related variables were analysed according to GDP per capita, including 14 "high GDP" countries with GDP per capita greater than US$24 000 and 11 "low GDP" countries with GDP per capita less than US$11 000.

Results: Disease activity DAS28 ranged between 3.1 and 6.0 among the 25 countries and was significantly associated with GDP (r = –0.78, 95% CI –0.56 to –0.90, r² = 61%). Disease activity levels differed substantially between "high GDP" and "low GDP" countries at much greater levels than according to whether patients were currently taking or not taking methotrexate, prednisone and/or biological agents.

Conclusions: The clinical status of patients with RA was correlated significantly with GDP among 25 mostly European countries according to all disease measures, associated only modestly with the current use of antirheumatic medications. 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.

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