Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Current Social Position Associated with Rheumatoid Arthritis Severity and Self-Reported Health Outcomes in African Americans.

Callahan1,  Leigh F., Cleveland1,  Rebecca J., Li1,  Xia, Schwartz1,  Todd A., Jonas1,  Beth L., Mikuls2,  Ted R., Schoster1,  Britta L.

University of North Carolina, Chapel Hill, NC
Omaha VA and University of Nebraska, Omaha, NE
University of Alabama at Birmingham, Birmingham, AL
Washington Univ School of Med, St. Louis, MO
Emory Univ School of Medicine, Atlanta, GA
Med Univ of South Carolina, Charleston, SC
University of Pittsburgh, Pittsburgh, PA
Marguerite Jones Harbert-Gene V. Ball, MD Professor of Medicine, and Director, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL


Socioeconomic status (SES), has been shown to be associated with rheumatoid arthritis (RA) prevalence as well as physical and psychosocial outcomes. Ethnicity is sometimes used as a surrogate for SES, but recent findings suggest this may not be appropriate. The purpose of this study is to evaluate whether SES is associated with RA disease severity and patient reported outcomes (PROs), independent of ethnicity, in a population of African Americans (AA) with RA.


A cross-sectional analysis was conducted on 855 AA patients with RA who were enrolled from medical centers in the southeastern US. SES measures were educational attainment (<= high school [HS] diploma, or >HS); occupation (OCC) (professional or non); home ownership (yes or no); and annual household income (INC) (<=$30,000 (30K) or >$30K). Outcomes were joint severity (tenderness, swelling and malalignment); radiographs (erosion, JSN score); laboratory measures (C-reactive protein [CRP] levels, rheumatoid factor [RF], and anti-cyclic citrullinated protein antibodies [anti-CCP]); and PROs (HAQ, pain and fatigue visual analog scales [VAS], helplessness Rheumatology Attitudes Index [RAI], and counts of poor physical, poor mental, and limited activity days). Covariates included gender, age, RA disease duration, current Methotrexate/Leflunomide and biologic agent use, clinical comorbidity index, and pack-years of cigarette smoking (0, <10, 10-<20, >=20). Bivariate analyses were performed to examine mean values of RA severity markers according to SES. Regression models were used to determine associations of each RA severity outcome and PROs with SES measures, adjusting for covariates. All analyses were also performed in a subset of those with RA <=2 years (N=413).


The mean age was 54 years, 84% were female, and average RA disease duration was 84 months. Approximately 57% had <=HS, 51% non-professional OCC, 52% non-homeowners, 71% INC<=$30K and 52% had ever smoked. In bivariate analyses, all measures of low SES were associated with poorer outcomes, with the strongest associations seen for <=$30K and non-homeowners with PROs (P<0.01). In a covariate-adjusted multivariable regression model examining all SES measures, significant independent associations with joint severity measures and most PROs were limited to INC <=$30K and homeowners. Similar results were seen in analyses limited to those with RA <=2 years.


In AA with RA, disease severity and low PROs are associated with low levels of SES, particularly for those with low household income and not owning a home. These data support the importance of SES with clinical and self-reported RA disease severity measures. Our finding that SES is a significant predictor of RA severity in a population limited to AA highlights the importance of SES outside of racial context.

To cite this abstract, please use the following information:
Callahan, Leigh F., Cleveland, Rebecca J., Li, Xia, Schwartz, Todd A., Jonas, Beth L., Mikuls, Ted R., et al; Current Social Position Associated with Rheumatoid Arthritis Severity and Self-Reported Health Outcomes in African Americans. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1545

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