{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T12:08:42Z","timestamp":1790165322288,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U54GM115458"],"award-info":[{"award-number":["U54GM115458"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000005","name":"U.S. Department of Defense","doi-asserted-by":"publisher","award":["PR200793"],"award-info":[{"award-number":["PR200793"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006260","name":"Rheumatology Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006260","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp;amp; Research"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To quantify the degree of financial distress and identify its determinants in adults with rheumatoid arthritis (RA) given the frequent prolonged use of expensive disease\u2010modifying therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified adults enrolled in the FORWARD databank with either RA or noninflammatory musculoskeletal disease (NIMSKD) completing the Functional Assessment of Chronic Illness Therapy\u2013Comprehensive Score for Financial Toxicity (FACIT\u2010COST) questionnaire. In this cross\u2010sectional study, FACIT\u2010COST was analyzed as a continuous (higher score indicates less financial distress) and binary variable (presence of financial distress with threshold &lt;26). Least Absolute Shrinkage and Selection Operator (LASSO) was applied to linear and logistic regression to select covariates for inclusion in multivariable models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Participants with RA (n = 2,277) had lower FACIT\u2010COST scores, indicating greater financial distress, than those with NIMSKD (n = 1,340) (mean of 30.2 \u00b1 SD 9.4 vs mean of 34.0 \u00b1 SD 8.4; unadjusted\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001). Assessed as a binary outcome, financial distress was more frequent in participants with RA than participants with NIMSKD (29% vs 15%; unadjusted\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001). Differences in financial distress by diagnosis persisted following multivariable adjustment. Among those with RA, determinants identified in multivariable models included depression (adjusted odds ratio 1.12; 95% confidence interval 1.09\u20131.16) and disease severity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Financial distress is prevalent in adults with RA and appears to be greatest in those with comorbidities, specifically depression, identifying a potential area for intervention. Notably, expensive biologic or targeted synthetic disease\u2010modifying antirheumatic drugs were not associated with FACIT\u2010COST scores.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acr.25670","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T07:29:21Z","timestamp":1760599761000},"page":"601-608","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Financial Distress and Its Determinants in Rheumatoid Arthritis"],"prefix":"10.1002","volume":"78","author":[{"given":"Amber Brown","family":"Keebler","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, Department of Internal Medicine University of Nebraska Medical Center  Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunju","family":"Im","sequence":"additional","affiliation":[{"name":"Department of Biostatistics College of Public Health, University of Nebraska Medical Center  Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Pedro","sequence":"additional","affiliation":[{"name":"FORWARD, The National Databank for Rheumatic Diseases  Wichita Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0897-2272","authenticated-orcid":false,"given":"Ted R.","family":"Mikuls","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine University of Nebraska Medical Center  Omaha"},{"name":"Medicine and Research Services, VA Nebraska\u2010Western Iowa Health Care System  Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward S.","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Epidemiology College of Public Health, University of Nebraska Medical Center  Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaleb","family":"Michaud","sequence":"additional","affiliation":[{"name":"FORWARD, The National Databank for Rheumatic Diseases  Wichita Kansas"},{"name":"Division of Rheumatology, Department of Internal Medicine University of Nebraska Medical Center  Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.28814"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.017793"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc22-0494"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1089\/jayao.2018.0143"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-016-1269-7"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2012-0279"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.7326\/M18-2136"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.7812\/TPP\/16-070"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2023.100661"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.23512"},{"issue":"5","key":"e_1_2_6_12_1","first-page":"S100","article-title":"The National Data Bank for Rheumatic Diseases (NDB)","volume":"34","author":"Michaud K.","year":"2016","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2017.10.024"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2022.28.9.997"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-205675"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2013.03.036"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1080\/13548506.2021.1971725"},{"issue":"1","key":"e_1_2_6_18_1","first-page":"12","article-title":"Comparison of two validated instruments to measure financial hardship in cancer survivors: comprehensive score for financial toxicity (COST) versus personal financial wellness (PFW) scale","volume":"31","author":"D'Rummo KA","year":"2022","journal-title":"Support Care Cancer"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2017.0161"},{"key":"e_1_2_6_20_1","doi-asserted-by":"crossref","DOI":"10.1177\/11786329211057352","article-title":"Re\u2010validation of the COmprehensive Score for Financial Toxicity (COST): assessing the scale's utility in chronic disease populations","volume":"14","author":"Pavela G","year":"2021","journal-title":"Health Serv Insights"},{"key":"e_1_2_6_21_1","author":"The FACIT Group","journal-title":"FACIT\u2010COST"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.5244"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2022.40.28_suppl.182"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2008.06.026"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22456"},{"issue":"5","key":"e_1_2_6_26_1","first-page":"S14","article-title":"The Health Assessment Questionnaire (HAQ)","volume":"23","author":"Bruce B","year":"2005","journal-title":"Clin Exp Rheumatol"},{"issue":"11","key":"e_1_2_6_27_1","first-page":"S14","article-title":"Measures of rheumatoid arthritis disease activity: Patient (PtGA) and Provider (PrGA) Global Assessment of Disease Activity, Disease Activity Score (DAS) and Disease Activity Score with 28\u2010Joint Counts (DAS28), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), Patient Activity Score (PAS) and Patient Activity Score\u2010II (PAS\u2010II), Routine Assessment of Patient Index Data (RAPID), Rheumatoid Arthritis Disease Activity Index (RADAI) and Rheumatoid Arthritis Disease Activity Index\u20105 (RADAI\u20105), Chronic Arthritis Systemic Index (CASI), Patient\u2010Based Disease Activity Score With ESR (PDAS1) and Patient\u2010Based Disease Activity Score without ESR (PDAS2), and Mean Overall Index for Rheumatoid Arthritis (MOI\u2010RA)","volume":"63","author":"Anderson JK","year":"2011","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-016-1151-6"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.2517-6161.1996.tb02080.x"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.2139\/ssrn.4452778"},{"key":"e_1_2_6_31_1","volume-title":"Stata Statistical Software: Release 17","year":"2021"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v033.i01"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol28020117"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.3969"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-018-1736-5"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10597-019-00519-0"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.7326\/M19-0537"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2017.024927"},{"issue":"5","key":"e_1_2_6_39_1","first-page":"S74","article-title":"Impact of trained oncology financial navigators on patient out\u2010of\u2010pocket spending","volume":"24","author":"Yezefski T","year":"2018","journal-title":"Am J Manag Care"}],"container-title":["Arthritis Care &amp; Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.25670","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/acr.25670","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.25670","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.25670","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T06:16:19Z","timestamp":1777788979000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/acr.25670"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,15]]},"references-count":38,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/acr.25670"],"URL":"https:\/\/doi.org\/10.1002\/acr.25670","archive":["Portico"],"relation":{},"ISSN":["2151-464X","2151-4658"],"issn-type":[{"value":"2151-464X","type":"print"},{"value":"2151-4658","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,15]]},"assertion":[{"value":"2025-03-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}