Study: Rheumatoid arthritis increases health care costs, harms mental health

OXFORD, Miss. – A University of Mississippi-led comprehensive study of a disorder that affects 4.27 million Americans nationwide is revealing just how significant its burdens are on patients' financial well-being and quality of life.    

Patients with rheumatoid arthritis, an inflammatory disorder known for causing joint pain and reducing mobility, pay an average of $3,383 more per year on health care expenditures than those without the disorder, according to the study published in ACR Open Rheumatology, the American College of Rheumatology’s journal.   

“This is a chronic disease that necessitates the continued use of medication,” said Yinan Huang, assistant professor of pharmacy administration and research assistant professor in the Research Institute of Pharmaceutical Sciences. Huang is the study's lead author.  

“Patients faced higher out-of-pocket costs or prescription medication costs as compared to the general population, and their mental as well as physical health-related quality-of-life are usually lower than the general population. All those factors play a role in what motivated us to proceed with this project.”  

Huang and co-authors Jieni Li, research assistant professor at the University of Houston, and Sandeep Krishna Agarwal, associate professor of rheumatology at the Baylor College of Medicine, analyzed data from the Medical Expenditure Panel Survey from 2018 to 2020 to understand the challenges and needs of those suffering from the disorder. 

About 40% of rheumatoid arthritis patients’ medical expenses were prescription medication, highlighting how steep the cost of managing this illness can be, Li said.  

"It's really a shock for both of us to see that RA patients spend so much on their prescriptions,” Li said. “We all knew that there are new RA treatments like biologics and that those are really expensive for the patient, but not to this extent.” 

Better understanding of the disease can help develop more support systems, better policies and more nuanced care of the population, Huang said.  

“We want to provide some solid data to the health care communities about the overall comprehensive burden facing this vulnerable group of patients,” she said. “And from the financial perspective, I would like to see more focus on the prescription medication-related costs.  

“Some intervention needs to be taken to increase access to treatment because of the costs.” 

Rheumatoid arthritis affects more than 18 million people worldwide, with about 70% of those patients being women and 55% being over the age of 55, according to the World Health Organization. Though the systemic autoimmune disease most commonly affects the joints, it may also damage the skin, lungs, heart and eyes.  

As the average age of Americans increases, the number of people with RA is expected to grow, Huang said.  

“If not treated well, it can lead to disability,” she said. “According to the (Centers for Disease Control), arthritis disease – not only RA, but all arthritis disease – is a leading cause of disability in the United States.” 

Besides health care and medication costs, patients with rheumatoid arthritis are also more likely to need daily support to go about their lives normally. This could take the form of mobility devices such as wheelchairs or walkers, in-home help or other accommodations.  

“From a quality-of-life, humanistic perspective, we all know the burden is huge on these patients,” Li said. “They suffer from limited mobility as well as pain, and so they are more likely to seek these supports. 

“When we’re looking at treatments, we should also consider this factor in the future. What supports (does) this patient have?” 

To better treat rheumatoid arthritis, health care workers must first understand the disease, the researchers said. The next step of their study will include comparing the severity of rheumatoid arthritis pain among patients to determine who is most affected by the disease.  

“These days, people are talking about individualized, personalized care,” Li said. “From the study’s objective, that’s what we want to provide more for RA patients.”