Financial Distress Can Significantly Impact Patients With Rheumatoid Arthritis

A significant number of people with rheumatoid arthritis (RA) experience financial distress, particularly if they also suffer from comorbidities like depression, according to a new study.

The report found that RA was associated with a greater financial burden than noninflammatory musculoskeletal disease (NIMSKD). The findings were published in Arthritis Care & Research.¹

The authors explained that while financial hardship is a key factor in facilitating shared decision-making, discussions between patients and providers often do not extend beyond health insurance status. The problem, they noted, is that insurance status alone does not predict financial hardship. They added that previous research has shown that most patients are eager to discuss costs with their physicians.²

Still, the authors said relatively little attention has been paid within the scientific community to the issue of financial distress among patients with rheumatic diseases like RA. That is despite the fact that a 2018 study found total per-person medical costs among people with RA exceed $36,000 per year.³

Investigators used data from the FORWARD databank, an ongoing longitudinal observational registry that collects patient-reported outcomes from people with rheumatic diseases using biannual questionnaires covering a range of topics, including sociodemographic factors.¹ The databank was previously known as the National Databank of Rheumatic Diseases. They identified 2277 patients with RA and 2340 with NIMSKD who had completed the Functional Assessment of Chronic Illness Therapy—Comprehensive Score for Financial Toxicity (FACIT-COST) questionnaire.

The investigators found patients with RA had greater financial distress than those with NIMSKD, with 29% of people with RA and 15% of people with NIMSKD meeting the criteria for financial distress (unadjusted; P < 0.01). The investigators said the difference was maintained even after multivariable adjustment.

The authors noted that the findings matched their hypothesis, namely that a significant proportion of people with RA experience financial distress. They said this shows there is a need for identifying modifiable risk factors for financial distress.

However, while their basic premise was affirmed by the research, the investigators said their hypothesis about why people face financial distress may not be correct. They theorized that patients’ distress would be due to higher utilization of expensive treatment modalities. However, the data showed that determinants of financial distress included decreased quality of life, disease severity, and comorbidities like obesity and depression.

“Strikingly, although unsurprising, depression is the most consistent association with financial distress in our analysis, regardless of diagnosis,” they noted. “The relationship between the two should be strongly considered in future longitudinal studies.”

On the other hand, expensive biologic or disease-modifying anti-rheumatic drugs (DMARDs) were not strongly associated with FACIT-COST scores, the authors said.

The findings have implications for everyday clinical care. They said clinics should consider screening patients for financial hardship, even if none is suspected. They said the use of financial navigators can also be appropriate and help reduce financial distress in patients.

The investigators said the patients in the FORWARD registry tended to be older in age and the patient population is predominantly White. Thus, they said their findings may not be generalizable to the entire population. They added that the relationship between disease severity, financial distress, and comorbidities is highly complex, and therefore future study is warranted to fully understand the links.

“These findings should motivate future prospective studies to elucidate causality and evaluate the utility for clinical implementation,” they said.

References

1. Keebler AB, Im Y, Pedro S, Mikuls TR, Peters ES, Michaud K. Financial distress and its determinants in rheumatoid arthritis. Arthritis Care Res (Hoboken). Published online October 16, 2025. doi:10.1002/acr.25670
2. Henrikson NB, Chang E, Ulrich K, King D, Anderson ML. Communication with physicians about health care costs: Survey of an Insured Population. Perm J. 2017;21:16-070. doi:10.7812/TPP/16-070
3. Hresko A, Lin TC, Solomon DH. Medical care costs associated with rheumatoid arthritis in the US: a systematic literature review and meta-analysis. Arthritis Care Res (Hoboken). 2018;70(10):1431-1438. doi:10.1002/acr.23512