Determinants of Disability in Rheumatoid Arthritis: A Community-Based Cohort Study

Megan L. Krause1, Cynthia S. Crowson2, Tim Bongartz4, Eric L. Matteson1, 3, Clement J. Michet1, Thomas G. Mason1, Scott T. Persellin1, Sherine E. Gabriel1, 3, John M. Davis, III*, 1
1 Division of Rheumatology, Department of Medicine;
2 Division of Biomedical Statistics and Informatics, Department of Health Sciences Research;
3 Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA;
4 Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

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© Krause et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Division of Rheumatology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; Fax: 507-284-0564; E-mail:


Longitudinal care of a community-based cohort of patients with rheumatoid arthritis (RA) was evaluated retrospectively. Candidate determinants of disability included visual analog scales (VAS) for patient global assessment and pain, comorbidities, and medications. The outcome was the ‘patient-acceptable symptom state’ for disability as defined by the Health Assessment Questionnaire (HAQ) disability index, using a cutoff of <1.04. Two-sample t tests and multivariable logistic regression were used to determine odds ratios (OR) for associations between predictor variables and disability. Out of a total of 99 patients, 28 (28%) patients had HAQ ≥1.04 at their last visit. The greatest odds of not attaining the patient-acceptable symptom state in a multivariable model was associated with corticosteroids (OR: 5.1; p=0.02), antidepressants (OR: 5.3; p=0.02), and female sex (OR: 6.5; p=0.05). In the era of biologic therapy, female sex, corticosteroids, and antidepressants remain profound determinants of disability highlighting the need to understand the underlying mechanisms.

Keywords: Depression, disability, rheumatoid arthritis.