Health literacy and control of inflammatory activity in patients with recent-onset rheumatoid arthritis

To determine the association between health literacy (HL) and disease activity in patients with recent-onset rheumatoid arthritis.

Cross-sectional study of patients with rheumatoid arthritis (RA) of ≤ 5 years' duration. Demographic, clinical and laboratory data were collected during routine follow-up visits. HL was assessed using the SAHLSA questionnaire, a validated measure of functional health literacy. A multivariate model was developed to evaluate the association between HL level and disease activity, measured by DAS28.

A total of 210 patients (81% women) were included with a mean age of 53.9 (14.1) years and a median disease duration of 1.6 [0.4-4.28] years. Low health literacy scores (SAHLSA ≤37) were identified in 10.9% (n = 23) of patients. These individuals showed significantly higher disease activity compared with those with higher SAHLSA scores: DAS28-ESR 3.9 (1.6) vs 2.8 (1.4) (P = 0.006), and DAS28-CRP 3.7 (1.4) vs 2.7 (1.2) (P < 0.000). Other measures-physician global assessment (VAS), tender and swollen joint counts, CRP, SDAI, CDAI, and SF-36-were also significantly worse in patients with low HL. In the multivariate analysis, compared with those with higher SAHLSA scores (OR 0.030; 95% CI 0.002-0.396; P = 0.008).

Low SAHLSA health literacy scores are independently associated with poorer control of inflammatory activity in patients with RA of ≤5 years' duration. Adapting healthcare communication and support strategies to patients' health literacy needs early in the disease course may contribute to improved RA management and outcomes.