Lower Socioeconomic Status Linked to Negative Illness Perception in Patients with Arthritis

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Patients with higher disease activity reported the highest perceived consequence of disease.

Several sociodemographic and clinical characteristics, including younger patients with a lower socioeconomic status and those with high disease burden, were linked to a negative illness perception in patients with inflammatory arthritis, according to a study published in Rheumatology International.1

Many patients with newly diagnosed arthritis find themselves faced with changes in family roles, working life, and social relationships. Therefore, both the American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR) suggest offering self-management resources and advice for these patients. Self-management is commonly defined as a person’s ability to manage lifestyle changes, treatments, symptoms, and psychosocial and physical consequences.2

“When newly diagnosed with inflammatory arthritis, acquiring self-management skills is beneficial, to enhance quality of life,” wrote a team of investigators led by Luise Holberg Lindgren, a PhD student at the Copenhagen Center for Arthritis Research (COPECARE) Center for Rheumatology and Spine Diseases Centre for Head and Orthopedics Rigshospitalet in Denmark. “The personal beliefs and mental representations patients hold about their illness, known as illness perception, significantly influence the development of these skills. Recognizing characteristics that affect illness perception is key to identifying patients requiring additional support for the development of self-management skills.”

The cross-sectional study was based on the Danish Mental Health in Inflammatory Arthritis (MaIA) study and used survey data from a cohort of adult patients diagnosed with inflammatory arthritis for ≤ 2 years. Eligible patients were recruited through the Danish Rheumatology Database (DANBIO) and participants were asked to complete the questionnaire through their digital mailbox, “e-Boks.” The index date was defined as the day subjects responded to the questionnaire.

Demographic characteristics of interest included age, sex, level of education, household income, cohabitant status, and the connection to the labor market, while clinical factors included disease activity, disease duration, pain, fatigue, and physical function. These characteristics were evaluated using a variety of measurement tools including the Disease Activity Score in 28 joints with an erythrocyte sedimentation rate (DAS-28 ESR), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Disease Activity Index for PSoriatic Arthritis (DAPSA), and the Multidimensional Health Assessment Questionnaire (MD-HAQ).

Illness perception was evaluated using the Brief Illness Perception Questionnaire (B-IPQ). The B-IPQ subdivided based on psychometric testing into the consequence domain and the control domain. A negative illness perception meant the patient perceived their illness as threatening to overall health and life.

In total, 1360 patients comprised of 61% females were included in the survey analysis. Approximately half (46%) of these patients were aged ≥ 61 years. Among this cohort, 64% were diagnosed with rheumatoid arthritis (RA), 20% had psoriatic arthritis (PsA), and 16% had axial spondyloarthritis (axSpA).

Patients with higher disease activity (odds ratio [OR] 3.026, confidence interval [CI] 2.208;4.147) reported the highest perceived consequence of disease. Additionally, younger patients with a lower socioeconomic status, a PsA or axSpA diagnosis, those with severe physical disability (OR 4.147. CI 2.883;6.007), severe fatigue (OR 2.612, CI 1.942;3.513), and severe pain (OR 3.034, CI 1.991;4.622) had a significantly higher likelihood of reporting a negative perception of their illness.

Investigators mentioned the cross-sectional study design as a limitation because they could not determine casual inference. Additionally, there is a possibility that unmeasured confounders, including psychological distress and comorbidities, could have increased the likelihood of negative illness perception. Interestingly, they noted patients who are experiencing higher levels of depression and anxiety may be less likely to respond to the questionnaire. Therefore, they included a non-responder analysis which found these patients had higher functional disability, were younger, and more had axSpA. This in turn could have led to a lower prevalence of these types of patients and therefore underestimated any association.

“Patients with these characteristics may require targeted attention and support within rheumatology clinical practice to facilitate the successful development of self-management skills,” investigators concluded.


  1. Lindgren LH, de Thurah A, Thomsen T, et al. Sociodemographic and clinical variables associated with negative illness perception in patients newly diagnosed with rheumatoid arthritis, axial spondyloarthritis, or psoriatic arthritis-a survey based cross-sectional study. Rheumatol Int. Published online April 2, 2024. doi:10.1007/s00296-024-05553-0
  2. Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J (2002) Self-management approaches for people with chronic conditions: a review. Patient Educ Couns 48:177–187. to ref 8 in article