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What Affects Care Complexity in Rheumatoid Arthritis? An Integrative Review of Complexity Domains and Associated
Kiran Dhiman1, Oscar Russell2, Catherine Hill3
1K. Dhiman, MPH, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
The Journal of Rheumatology
|July 15, 2026
Summary
Care complexity in rheumatoid arthritis (RA) involves 12 domains impacting patient outcomes like function and quality of life. Understanding these factors is key to tailoring care for people living with RA.
Area of Science:
- Rheumatology
- Health Services Research
- Social Determinants of Health
Background:
- Care complexity arises from the interplay of health status and social determinants of health.
- It can significantly affect patient care, leading to longer appointments and increased healthcare utilization for individuals with rheumatoid arthritis (RA).
Purpose of the Study:
- To identify RA-related care complexity domains.
- To determine the associated patient outcomes.
Main Methods:
- An integrative literature review was performed.
- Searches were conducted in MEDLINE using relevant keywords and MeSH terms from 2000 to the present.
- Data were analyzed using the constant comparison method.
Main Results:
- 181 articles were included from 9835 initial results.
- Identified care complexity domains: co/multimorbidity, polypharmacy, obesity, substance use, mental health, chronic pain, difficult-to-treat RA, cognitive impairment, advanced age/frailty, race/ethnicity, socioeconomic factors, social support, and healthcare access.
- Common outcomes included impaired function, reduced quality of life, increased mortality risk, higher disease activity, and greater healthcare utilization. Intersectionality of domains worsened outcomes.
Conclusions:
- Twelve distinct domains of care complexity and five key patient outcomes were identified in RA.
- These findings will guide the creation of a care complexity framework and measurement tools to personalize patient care.
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