The association between social deprivation and disease activity in rheumatoid arthritis: A systematic literature review

Mrinalini Dey, Amanda Busby, Helen Ewell, Heidi Lempp, Arthur Pratt, Adam Young, John Isaacs, Elena Nikiphorou

Research output: Contribution to journalArticlepeer-review


Physical and mental illnesses are driven by ethnicity, social, environmental and economic determinants. Novel theoretical frameworks in rheumatoid arthritis (RA) focus on links and adverse interactions between and within biological and social factors.
This review aimed to summarise associations between socioeconomic status (SES) and RA disease activity, and implications for future research.

Articles studying the association between SES and RA disease activity were identified, from 1946 until March 2021. The research question was: Is there an association between social deprivation and disease activity in people with rheumatoid arthritis?
Articles meeting inclusion criteria were examined in detail by one author, with 10% screened at abstract and full paper stage by a second author. Disagreements were resolved with input from a third reviewer. Information was extracted on definition/measure of SES, ethnicity, education, employment, comorbidities, disease activity and presence/absence of association between SES and disease activity.

Initially, 1750 articles were identified, with 30 articles ultimately included. SES definition varied markedly- ten articles used a formal scale and most used educational attainment as a proxy. Most studies controlled for lifestyle factors including smoking and BMI, and comorbidities. 25 articles concluded an association between SES and RA disease activity, two were unclear, and three found no association.

We have demonstrated the association between low SES and worse RA disease outcomes, underpinned by complex multifaceted relationships. There is a need for increased application of mixed-methods methodology and consideration of syndemic frameworks to understand bio-bio and bio-social interactions, to examine disease drivers and clinical outcomes holistically.

Summary points
1.Relationships underpinning the association between low socioeconomic status and worse outcomes in rheumatoid arthritis are complex.
2.Novel theoretical frameworks can increase our understanding of these bio-bio and bio-social interactions.
3.Increased understanding of the complex association between socioeconomic status and disease activity will facilitate more holistic approaches to patient care.
Original languageEnglish
JournalRMD Open
Publication statusAccepted/In press - 29 Mar 2022


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