SAT0703-HPR THE HEALTH INEQUALITIES ASSOCIATED WITH SEVERE MENTAL ILLNESS IN PEOPLE WITH RHEUMATOID ARTHRITIS
Authors: Hayley McBain, Matthew Bezzant, Ailsa Bosworth
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> People with conditions such as schizophrenia, schizoaffective disorder, bipolar disorder, personality disorder and depression with psychosis are vulnerable and face a number of health inequalities,<sup>1,2</sup> including poorer healthcare. This may explain why those with a severe mental illness (SMI) die younger.<sup>3</sup> In arthritis, people with psychotic disorders who are over 65 are less likely to receive nonsteroidal anti-inflammatory drugs (NSAIDS) and disease-modifying anti-rheumatic drugs (DMARDS), than those without a psychotic disorder.<sup>4</sup> However, little is known about the prevalence of these conditions or whether disease outcomes differ to those in the broader rheumatoid arthirtis (RA) population. <h3>Objectives</h3> To establish the proportion of people with RA who are living with a SMI and whether fatigue, pain, function and disease activity differs to that of the general RA population. <h3>Methods</h3> The 2018 National Rheumatoid Arthirtis Society (NRAS) 'Emotional Health and Well-being Matters' survey was designed by people with RA and researchers. This included a questionnaire designed to capture self-reported co-morbidities and measures of fatigue and pain using a 100-point visual analogue scale, quality of life (using the shortened Arthritis Impact Measurement Scale<sup>5</sup>), functional disability (using the Health Assessment Questionnaire<sup>6</sup>) and patient-based disease activity.<sup>7</sup> Participants were recruited by NRAS via their social media platforms, membership and non-membership lists and in newsletters and the NRAS HealthUnlocked forum. The survey was open from May-July 2018. Recruitment was focused on those diagnosed with RA aged 18 years and over and living in the UK. <h3>Results</h3> A total of 1565 people with RA completed the survey, 2% (n=29) of whom reported having a diagnosis of SMI, the most common being bipolar disorder (n=12). After adjusting for age and gender, those with RA and a SMI experienced significantly greater levels of pain (p=0.04), functional disability (p=0.01), along with poorer disease activity (p=0.03) and poorer quality of life (p&lt;0.03) than those with RA, but without SMI. There was however, no significant difference in the receipt of DMARDS or NSAIDS between the two groups (p&gt;0.12). <h3>Conclusion</h3> Prevalence rates of SMI are no greater in RA than the general population. Those with RA and a SMI do however experience significantly poorer clinical outcomes than people with RA but without SMI despite being in receipt of similar medications. Further research is needed to explore why these health inequalities exist and how best to ensure more positive outcomes for this vulnerable population. <h3>References</h3> [1] Thornicroft G. Physical health disparities and mental illness: the scandal of premature mortality. Br J Psychiatry 2011; 199(6):441-442. [2] Shiers D, Bradshaw T, Campion J. Health inequalities and psychosis: time for action. Br J Psychiatry 2015; 207(6):471-473. [3] De Hert M, Correll CU, Bobes J, Cetkovich-Bakmas MARC, Cohen DAN, Asai I, et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 2011; 10(1):52-77. [4] Redelmeier DA, Tan SH, Booth GL. The treatment of unrelated disorders in patients with chronic medical diseases. N Engl J Med 1998; 338(21):1516-1520. [5] Guillemin F, Coste J, Pouchot J, Ghézail M, Bregeon C, Sany J. The AIMS2−SF. A short form of the arthritis impact measurement scales 2. Arthritis Rheum 1997; 40(7):1267-1274. [6] Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum 1980; 23(2):137-145. [7] Choy EH, Khoshaba B, Cooper D, MacGregor A, Scott DL. Development and validation of a patient−based disease activity score in rheumatoid arthritis that can be used in clinical trials and routine practice. Arthritis Care Res (Hoboken) 2008; 59(2):192-199. <h3>Disclosure of Interests</h3> None declared