Clinically suspect arthralgia patients with a low educational attainment have an increased risk of developing inflammatory arthritis

Sarah J H Khidir*, Anna M P Boeren, Annelies Boonen, Pascal H P de Jong, Elise van Mulligen, Annette H M van der Helm-van Mil

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVES: Cross-sectional studies have shown that rheumatoid arthritis is more prevalent among people with a lower educational attainment. No longitudinal data are present on educational attainment in the at-risk phase of clinically suspect arthralgia (CSA). We therefore analyzed the association between educational attainment and progression from CSA to inflammatory arthritis (IA), and performed mediation analysis with subclinical joint-inflammation to elucidate pathways of this association.

METHODS: 521 consecutive patients presenting with CSA were followed for IA-development during median 25 months. Educational attainment was defined as low (lower secondary vocational education), intermediate, or high (college/university education). Subclinical inflammation in hand and foot joints was measured at presentation with contrast enhanced 1.5 T-MRI. Cox-regression was used to analyze IA-development per educational attainment. A three-step mediation analysis evaluated whether subclinical joint-inflammation was intermediary in the path between educational attainment and IA-development, before and after age-correction. Association between educational attainment and IA-development was verified in an independent CSA-cohort.

RESULTS: Low educational attainment was associated with increased IA-development (HR = 2.35, 95%CI = 1.27-4.33, p= 0.006), independent of BMI and current smoking-status (yes/no). Moreover, patients with a low educational attainment had higher levels of subclinical inflammation, which also was associated with IA-development. Partial mediation effect of subclinical inflammation was observed in the relationship between education and IA-development. Low educational attainment was also associated with increased IA-development in the validation cohort (HR = 5.72, 95%CI = 1.36-24.08, p= 0.017).

CONCLUSION: This is the first study providing evidence that lower educational attainment is associated with a higher risk of progressing from arthralgia to IA. This effect was partially mediated by subclinical joint inflammation.

Original languageEnglish
Pages (from-to)1944-1949
Number of pages6
JournalRheumatology
Volume62
Issue number5
Early online date3 Aug 2022
DOIs
Publication statusPublished - 2 May 2023

Keywords

  • Educational attainment
  • RHEUMATOID-ARTHRITIS
  • clinically suspect arthralgia
  • rheumatoid arthritis
  • socio-economic status

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