title: Association between socioeconomic status, learned helplessness, and disease outcome in patients with inflammatory polyarthritis.
abstract: OBJECTIVE
  Independent investigations have shown that socioeconomic status (SES) and learned helplessness (LH) are associated with poor disease outcome in patients with rheumatoid arthritis (RA). Our aim was to investigate the cross-sectional relationship between SES, LH, and disease outcome in patients with recent-onset inflammatory polyarthritis (IP), the broader group of conditions of which RA is the major constituent.
  
  
  METHODS
  SES was measured using the Index of Multiple Deprivation 2007 for 553 patients consecutively recruited to the Norfolk Arthritis Register. Patients also completed the Rheumatology Attitudes Index, a measure of LH. SES and LH were investigated as predictors of disease outcome (functional disability [Health Assessment Questionnaire (HAQ)] and disease activity [Disease Activity Score in 28 joints]) in a regression analysis, adjusted for age, sex, and symptom duration. The role of LH in the relationship between SES and disease outcome was then investigated.
  
  
  RESULTS
  Compared to patients of the highest SES, those of the lowest SES had a significantly worse outcome (median difference in HAQ score 0.42; 95% confidence interval [95% CI] 0.08, 0.75). Compared to patients with normal LH, patients with low LH had a significantly better outcome and patients with high LH had a significantly worse outcome (median difference in HAQ score 1.12; 95% CI 0.82, 1.41). There was a significant likelihood that LH mediated the association between SES and disease outcome (P = 0.04).
  
  
  CONCLUSIONS
  LH is robustly associated with cross-sectional disease outcome in patients with IP, and appears to mediate the relationship between SES and disease outcome. As LH is potentially modifiable, these findings have potential clinical implications.
authors.affiliation: Arthritis Research UK Epidemiology Unit, School of Translational Medicine, University of Manchester, UK.
authors.forename: E M
authors.initials: EM
authors.lastname: Camacho
authors.forename: S M M
authors.initials: SM
authors.lastname: Verstappen
authors.forename: D P M
authors.initials: DP
authors.lastname: Symmons
mesh_terms: D000328:Adult; D000368:Aged; D001168:Arthritis / Q000191:economics* / Q000473:pathology / Q000523:psychology*; D001172:Arthritis, Rheumatoid / Q000191:economics / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006380:Helplessness, Learned; D006801:Humans; D007249:Inflammation / Q000191:economics / Q000453:epidemiology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D012042:Registries; D012923:Social Class; D016896:Treatment Outcome