Do patients with rheumatic diseases living in rural settings have poorer outcomes? Results from a systematic review of the literature.
OBJECTIVES: To assess whether clinical and patient-reported outcomes are poorer for people with inflammatory and non-inflammatory rheumatic diseases living in rural locations. METHODS: We searched six databases for articles which were primary peer-reviewed research, published in English 1990-2019, which focussed on selected rheumatic diseases (rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis (axSpA) or osteoarthritis (OA)), and quantified either patient-reported or clinically measured outcomes by a measure of rurality or remoteness. Selected articles were synthesised narratively. RESULTS: Eight eligible publications, including 753 rural and 929 urban patients, evaluated outcomes in RA (5 studies) and OA (3 studies). Studies were small, single centre, and rarely provided a definition of rurality. Aspects relating to rurality, such as access to services, were not measured. In RA some studies suggested greater functional disability and disease activity in rural dwellers. In OA, there was some evidence to suggest that rural dwellers presented with more advanced degenerative hip changes, and that illness perceptions and coping differed between rural and urban dwellers. No studies examined work outcomes. Potentially important confounding factors such as socio-economic status were rarely considered. CONCLUSION: There remains considerable uncertainty whether outcomes differ for rheumatic disease patients in rural settings. There is a need for larger-scale studies characterising participants in relation to place of residence, in order to determine whether rurality is an independent predictor of outcome or a surrogate marker for socioeconomic factors.