SummaryBackground Health literacy has been deemed central to the prevention and control of non-communicable diseases by WHO, including rheumatic and musculoskeletal diseases. However, the association between health literacy, other social determinants of health, and outcomes in people with inflammatory arthritis remains poorly understood. This study aimed to assess the associations between health literacy, social determinants of health, and clinical, mental health, and work-related outcomes in people with inflammatory arthritis. Methods This cross-sectional study used individual-level data from patients with confirmed inflammatory arthritis enrolled in the National Early Inflammatory Arthritis Audit (NEIAA) in England. Individuals were invited to complete an online survey, comprising the nine-domain Health Literacy Questionnaire; validated questionnaires on work, anxiety, and depression; and information on sociodemographics, treatment history, and self-reported disease activity. Responses were matched with NEIAA records. The main outcomes were self-reported disease activity, employment status, depression, Rheumatic Disease Comorbidity Index, and corticosteroid use. Multivariable regression analyses adjusting for age, sex, and other relevant covariates were done to assess associations between health literacy and outcome variables. People with lived experience of rheumatoid arthritis were involved in the design and conduct of this study. Findings Between March 26, 2024, and May 8, 2024, 995 participants responded to the survey. Median age of participants was 59 years (IQR 50–67). 657 (66%) were female and 338 (34%) were male. Lower health literacy across all Health Literacy Questionnaire domains was associated with higher self-reported disease activity and greater symptoms of depression. For disease activity, the greatest magnitude of strength of association was observed for having sufficient information to manage their own health (β –17·04 95% CI –20·69 to –13·39), ability to find good health information (–12·40 –15·60 to –9·19), and understanding health information well enough to know what to do (–13·23 –16·63 to –9·84). For depression, the greatest magnitude of strength of association was observed for having sufficient information to manage their own health (β –0·93 95% CI –1·13 to –0·74) and social support for health (–0·89 –1·08 to –0·71). Lower ability to find good health information (β –0·10 95% CI –0·19 to –0·01) and understanding health information well enough to know what to do (–0·16 –0·25 to –0·06) were associated with greater comorbidity burden. Higher corticosteroid use was strongly associated with lower ability to find good health information (risk ratio 0·56 0·43 to 0·73) and understanding of health information (0·62 0·45 to 0·84). Employment status was not significantly associated with lower scores in most of the Health Literacy Questionnaire domains. Outcomes were unchanged after controlling for education. Interpretation Lower health literacy is associated with poorer physical and mental health, poorer work outcomes, and greater comorbidity burden in people with inflammatory arthritis. Improving access to, and the quality of, health information might help to tailor management and support improved outcomes. Funding Foundation for Research in Rheumatology and the King's College Hospital Charity.
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