Financial Distress and Its Determinants in Rheumatoid Arthritis.

Abstract

To quantify the degree of financial distress and identify its determinants in adults with rheumatoid arthritis (RA) given the frequent prolonged use of expensive disease-modifying therapies. We identified adults enrolled in the FORWARD databank with either RA or noninflammatory musculoskeletal disease (NIMSKD) completing the Functional Assessment of Chronic Illness Therapy-Comprehensive Score for Financial Toxicity (FACIT-COST) questionnaire. In this cross-sectional study, FACIT-COST was analyzed as a continuous (higher score indicates less financial distress) and binary variable (presence of financial distress with threshold <26). Least Absolute Shrinkage and Selection Operator (LASSO) was applied to linear and logistic regression to select covariates for inclusion in multivariable models. Participants with RA (n = 2,277) had lower FACIT-COST scores, indicating greater financial distress, than those with NIMSKD (n = 1,340) (mean of 30.2 ± SD 9.4 vs mean of 34.0 ± SD 8.4; unadjusted P < 0.001). Assessed as a binary outcome, financial distress was more frequent in participants with RA than participants with NIMSKD (29% vs 15%; unadjusted P < 0.001). Differences in financial distress by diagnosis persisted following multivariable adjustment. Among those with RA, determinants identified in multivariable models included depression (adjusted odds ratio 1.12; 95% confidence interval 1.09-1.16) and disease severity. Financial distress is prevalent in adults with RA and appears to be greatest in those with comorbidities, specifically depression, identifying a potential area for intervention. Notably, expensive biologic or targeted synthetic disease-modifying antirheumatic drugs were not associated with FACIT-COST scores.