Background/Purpose: Health literacy is the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. It is being increasingly recognized as important determinant to health outcomes. Patients with low health literacy are less able to manage chronic conditions effectively. The aim of our study was to measure the level of health literacy in patients with Rheumatoid Arthritis (RA) and assess its association with clinical outcomes.

Methods: A multicenter cross-sectional study was conducted.  Patient were recruited from 7 outpatients clinics including consecutive patients with diagnosis of RA according to American College of Rheumatology (ACR) 1987 criteria and/or ACR/European League Against Rheumatism (EULAR) 2010 criteria. Health literacy was assessed using the Test of Functional Health Literacy in Adults (S-TOFHLA) (0-36, 0 worst health literacy). Patients were categorized as having low or adequate health literacy using the standard cutoff (<23). Patient reported clinical outcomes included the  Clinical Disease Activity Index (CDAI) and the Health Assessment Questionnaire (HAQ) . We also collected data regarding patient demographics, comorbidities and treatment adherence -. Adherence to treatment was assessed using the Compliance Questionnaire Rheumatology (CQR; 0 - 100, 0 low adherence).  The association between health literacy and clinical/functional outcomes were evaluated using univariate and multivariate models adjusting by age, gender, educational level, disease duration and treatment adherence.

Results: Three hundred and thirty-eight patients were included, 84 % were female, mean age was 53 ± 12 years, disease duration 13 ± 10 years, CDAI 13 ± 11 and HAQ 1.00 ± 0.75. Mean S-TOFHLA score was 26 ±12. Three hundred and two patients (76%) had adequate health literacy. These patients had significantly lower age (r=-0.22, p<0.01), higher level of education(r=0.40, p<0.01), less number of comorbidities(r=-0.13, p<0.01) and shorter disease duration(r=-0.14, p<0.01).  After adjusting for multiple confounders, patients with low level of health literacy showed significantly higher disease activity (b = 3.7, p=0.01). Health literacy was not associated with HAQ (b=0.14, p=0.14). Using S-TOFHLA as continuous variables did not affect the results.

Conclusion: A quarter of patients with rheumatoid arthritis had inadequate health literacy, showing higher level of disease activity. Physicians should recognize that literacy levels of their patients could affect clinical outcomes, and provide appropriate interventions to ease this burden.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-impact-of-inadequate-health-literacy-on-disease-activity-in-patients-with-rheumatoid-arthritis/