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.


Early Rheumatoid Arthritis in Latin America. Low Socioeconomic Status Relates to High Disease Activity At Baseline.

Massardo1,  Loreto, Pons-Estel2,  Bernardo A., Cardiel3,  Mario H., Galarza-Maldonado4,  Claudio, Sacnun5,  Mónica P., Soriano6,  Enrique R., Laurindo7,  Ieda

Catholic University of Chile, Santiago 114-D, Chile
Pontificia Universidad Catolica de Chile, Santiago, Chile
Centro de Investigaciones Médico Quirúrgicas, Habana, Ciudad Habana, Cuba
Instituto Salvadoreño del Seguro Social, San Salvador, El Salvador
Universidad Catolica de Chile, Santiago, Chile
UCLA Medical School, Los Angeles, CA
Hospital Provincial, Rosario, Argentina
Hospital General "Dr. Miguel Silva", Morelia, Mexico
Hospital Monte Sinai, Cuenca, Ecuador
Hosp. Provincial, Rosario, Argentina
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Universidade de São Paulo, Sao Paulo, Brazil
Hospital Nacional "Guillermo Almenara Irigoyen", Lima, Peru
Continential Med Ctr, Barranquilla, Colombia

Background/Purpose:

To determine the influence of social factors on disease activity at baseline in a large multinational inception cohort of Latin American (LA) patients with early rheumatoid arthritis (RA).

Patients and Methods:

Patients with early RA (<1 year disease duration from first symptoms, >=18 years old) were examined between 2004/05 and followed for 3 years. Patients attended 46 rheumatology centers in 14 LA countries. Clinical evaluation, ethnicity, socioeconomic status (SES) (Graffar's method), DAS28-ESR, HAQ-DI, and hand and feet radiographs were performed and recorded on an agreed data base (ARTHROS 6.1). Chi-square, Kruskal Wallis or Mann Whitney U tests (p value<0.01) were used for comparisons. Multivariate analyses were applied to evaluate the influence of all the above factors.

Results:

Among the 1,093 patients who had been enrolled in July 2005, 85.3% were females. Mestizo (mixed European and Amerindians): 43%, Caucasians: 31%, African-LA (ALA): 19%, Amerindians: 4%, Others: 3%. 58% were in the lower or middle-lower SES; 41.7% had < 8 yrs of education; 44% had no or only some medical insurance coverage. Separated/divorced/widowed: 14%, and married/single: 86%. Age at onset: 46 (SD: 14) years; duration of disease at baseline 6.7 (SD: 3.2) months. Women and Mestizo, ALA, and Amerindian had earlier onset (5 years) than men or Caucasians (p < 0.01). Disease was clinically quite active- DAS28 score 6.0 (SD: 1.7) and moderately functionally disabling: HAQ-DI 1.29 (SD: 0.87). Surprisingly, joint erosions were present in only 25% (no stat. differences among ethnic groups).

ANCOVA multivariate analysis showed low/low middle SES, female sex and partial insurance are associated with both worse HAQ-DI and higher DAS28. Marital status was only associated with HAQ-DI, while older age was only associated with DAS28. Logistic regression analysis showed that older age, lack of insurance, and ethnic groups Amerindian and Other associated with the presence of erosions. When models included country of origin, differences between countries were found. (Cuba had highest HAQ-DI and DAS28 scores while Venezuela had lowest HAQ-DI and DAS28).

Conclusion:

This report compares early RA patients from the four LA main ethnic groups. Women and LA ethnicities (Amerindian, ALA, Mestizo) had significantly younger RA onset. Higher HAQ-DI and DAS28 scores related to poor SES status, femaleness and partial insurance suggesting that poverty/low/ middle low SES influence are important factors in determining disease activity. A more genetic related background for erosions is possible.

Funding:

supported by an unrestricted grant from Abbott Laboratories.

To cite this abstract, please use the following information:
Massardo, Loreto, Pons-Estel, Bernardo A., Cardiel, Mario H., Galarza-Maldonado, Claudio, Sacnun, Mónica P., Soriano, Enrique R., et al; Early Rheumatoid Arthritis in Latin America. Low Socioeconomic Status Relates to High Disease Activity At Baseline. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2117
DOI:

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