Financial Distress and its Determinants in Rheumatoid Arthritis.

Objective: To quantify the degree of financial distress and identify its determinants in adults with rheumatoid arthritis (RA) given the frequent chronic use of expensive disease modifying therapies.

Methods: We identified adults enrolled in the FORWARD databank with either RA or non-inflammatory 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.

Results: Participants with RA (n=2277) had lower FACIT-COST scores indicating greater financial distress than those with NIMSKD (n=1340) (meanof 30.2±9.4 vs. 34.0±8.4; unadjusted-p<0.001). Assessed as a binary outcome, financial distress was more frequent in RA than 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 (aOR 1.12; 95% CI 1.09-1.16) and disease severity.

Conclusion: 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 anti-rheumatic drugs were not associated with FACIT-COST scores.