U521714.pdf (9.21 MB)
A comparison of Gujarati Asian and Caucasian patients with rheumatoid arthritis
thesisposted on 2014-12-15, 10:31 authored by Catherine Ellen Neville
This study examined Gujarati and Caucasian patients with RA, with respect to disease activity, genetic factors, treatment, socioeconomic and psychological status.;61 Gujarati and 61 Caucasian subjects underwent a structured interview, including detailed social history, disease history, drug history, pain on VAS, HAQ, WHO Self Reporting Questionnaire, list of Threatening Life Events and an examination including a swollen joint count.;Caucasian patients had higher swollen joint counts (10.39 vs. 8.07, p=0.05), more nodulosis (46% vs. 16%, p=0.0005) and more sero-positivity for RF (66% vs. 45%, p=0.02). Gujaratis had longer EMS (1.36 hrs vs. 0.86 hrs, p=0.03), greater pain on VAS (5.1 vs. 3.7, p=0.0008) and greater disability on HAQ (1.9 vs. 1.2, p=0.0001). Gujaratis had an earlier age of onset (42.0 yrs vs. 46.3 years, p=0.01). There were no differences in DMARD therapy, but Gujaratis perceived their treatment to be less effective (p=0.0009). 76% of patients had tried complementary therapies.;Gujarati patients had a lower frequency of HLA DRB1 shared epitope (0.77 vs. 1.12 copies/patient, p=0.01). Caucasians expressed HLA DRB1*04 (37% vs. 12%, p=0.001) and DRB1*01 (15% vs. 1% p=0.0007). Gujaratis expressed HLA DRB1*10 (21% vs. 3%, p=0.0009).;59% Gujaratis were not working because of ill health, compared with 31% Caucasians. Gujaratis had a larger social network (3.15 vs. 1.89, p=0.0004) and more social services support (75% vs. 54%, p=0.01). 44% Gujarati patients were vegetarian, and few dark or smoked. Gujarati patients were significantly depressed (9.44 vs. 5.16 on SRQ, p<0.0001), and ethnicity was an independent risk factor for depression (p<0.0005) when other variables were adjusted for.;Ethnicity was an independent predictor for disability (p=0.001) despite adjusting for markers of disease severity and activity. Asian patients had an odds ratio of 8.20 (p=0.006) of having a HAQ >=2. Ethnicity was not a predictor for SJC.
Date of award2008-01-01
Awarding institutionUniversity of Leicester