TY - JOUR
T1 - Clinically suspect arthralgia patients with a low educational attainment have an increased risk of developing inflammatory arthritis
AU - Khidir, Sarah J H
AU - Boeren, Anna M P
AU - Boonen, Annelies
AU - de Jong, Pascal H P
AU - van Mulligen, Elise
AU - van der Helm-van Mil, Annette H M
N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology.
PY - 2023/5/2
Y1 - 2023/5/2
N2 - 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.
AB - 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.
KW - Educational attainment
KW - RHEUMATOID-ARTHRITIS
KW - clinically suspect arthralgia
KW - rheumatoid arthritis
KW - socio-economic status
U2 - 10.1093/rheumatology/keac446
DO - 10.1093/rheumatology/keac446
M3 - Article
C2 - 35920786
SN - 1462-0324
VL - 62
SP - 1944
EP - 1949
JO - Rheumatology
JF - Rheumatology
IS - 5
ER -