Clinically suspect arthralgia patients with a low educational attainment have an increased risk of developing inflammatory arthritis.
Educational attainment
clinically suspect arthralgia
rheumatoid arthritis
socio-economic status
Journal
Rheumatology (Oxford, England)
ISSN: 1462-0332
Titre abrégé: Rheumatology (Oxford)
Pays: England
ID NLM: 100883501
Informations de publication
Date de publication:
02 05 2023
02 05 2023
Historique:
received:
17
05
2022
revised:
22
07
2022
medline:
3
5
2023
pubmed:
4
8
2022
entrez:
3
8
2022
Statut:
ppublish
Résumé
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 analysed 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. A total of 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 analyse 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. 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). 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.
Identifiants
pubmed: 35920786
pii: 6654610
doi: 10.1093/rheumatology/keac446
pmc: PMC10152278
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1944-1949Commentaires et corrections
Type : CommentIn
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology.
Références
Curr Opin Rheumatol. 2014 Jan;26(1):64-71
pubmed: 24247116
RMD Open. 2017 Mar 14;3(1):e000324
pubmed: 28326188
Ann Rheum Dis. 2022 Jan;81(1):48-55
pubmed: 34285049
Ann Rheum Dis. 2005 Nov;64(11):1588-94
pubmed: 15843455
Ann Rheum Dis. 2017 Mar;76(3):491-496
pubmed: 27991858
Ann Rheum Dis. 2016 Mar;75(3):540-6
pubmed: 25630346
Rheumatology (Oxford). 2017 Jul 1;56(7):1051-1052
pubmed: 27940587
Clin Exp Rheumatol. 2018 Jul-Aug;36(4):589-594
pubmed: 29465359
Rheumatology (Oxford). 2016 Jul;55(7):1217-24
pubmed: 27012686
Ann Rheum Dis. 2014 Jul;73(7):1316-22
pubmed: 24550173
Trials. 2020 Oct 16;21(1):862
pubmed: 33076964
RMD Open. 2022 Apr;8(1):
pubmed: 35450954
Curr Rheumatol Rep. 2021 Apr 28;23(6):41
pubmed: 33913032
J Gen Intern Med. 2009 Nov;24(11):1211-6
pubmed: 19760299
J Pers Soc Psychol. 1986 Dec;51(6):1173-82
pubmed: 3806354
Lancet. 2016 Oct 22;388(10055):2023-2038
pubmed: 27156434
Rheumatology (Oxford). 2021 Oct 2;60(10):4591-4597
pubmed: 33470401