Original article Socioeconomic impact of rheumatoid arthritis in Morocco Hanan Rkain a, *, Fadoua Allali a , Imane Jroundi b , Najia Hajjaj-Hassouni a a Rheumatology B Department, El Ayachi Hospital, Rabat-Salé Teaching Hospital, Salé, Morocco b Biostatistics, Clinical Research, and Epidemiology Laboratory (LBRCE), Rabat School of Medicine and Pharmacy, Rabat, Morocco Received 28 September 2004; accepted 31 March 2005 Available online 04 November 2005 Abstract Objective. – To estimate the socioeconomic impact of rheumatoid arthritis (RA) in Morocco. Materials and methods. – We identified 100 consecutive patients (88 women and 12 men) with RA receiving follow-up either at a teaching hospital or from office-based physicians. For each patient, we recorded direct costs, indirect costs (productivity losses), and intangible costs (deterioration in the social domain of quality of life). Results. – Mean age at symptom onset was 31 ± 13.6 years and mean disease duration was 12.8 ± 7.8 years. RA-related expenses caused financial difficulties for 90% of patients, resulting in poor treatment compliance (61% of cases) and school absenteeism in the children (19% of cases). Of the 34 patients who had paid jobs at symptom onset, 65% stopped working, 6.9 years on average after the diagnosis. Older age, male gender, and a physically strenuous job were associated with stopping work. Six women (10% of married patients) divorced because of their disease. Sexual problems were reported by 67% of patients. The ability to perform domestic chores was affected in 84% of cases and participa- tion in leisure activities in 46% of cases. Conclusion. – RA has a major socioeconomic impact on affected families. In addition to the disease itself, the low socioeconomic status of many patients and the inadequate social welfare and health insurance systems contribute to the burden. © 2005 Published by Elsevier SAS. Keywords: Rheumatoid arthritis; Socioeconomic impact; Morocco 1. Introduction Rheumatoid arthritis (RA) is a chronic disease in which joint destruction eventually leads to deformities and disabil- ities. Most studies of RA focus on physical changes. However, information on other aspects is essential to the development of effective management programs for chronic diseases. RA not only causes physical impairments, but also places a huge eco- nomic burden on the patient, family, and society. Furthermore, RA affects everyday life and the ability of patients to engage in social activities. The socioeconomic impact of RA is a focus of increasing research attention [1,2]. No reports of studies of the socioeconomic impact of RA in Morocco are available. We conducted a study of RA patients in Morocco to estimate the cost of medications paid for by the patient and family and the financial burden placed by RA on the patient and family; to assess the impact of RA on work capacity, family interactions, and social activities; and to iden- tify factors associated with discontinuation of work and with alterations in social activities. 2. Materials and methods 2.1. Study sample We studied a random sample of 100 consecutive patients who met American College of Rheumatology (ACR) criteria for RA [3]. The patients were recruited at the El Ayachi Teach- ing Hospital and at physicians’ offices. 2.2. Data collection First the patients were informed of the study objectives, then they completed a 40-item questionnaire developed for this study with the contribution of the Sociology Department at http://france.elsevier.com/direct/BONSOI/ Joint Bone Spine 73 (2006) 278–283 * Corresponding author. Tel.: +11 212 6148 0121. E-mail address: hananrkain@yahoo.fr (H. Rkain). 1297-319X/$ - see front matter © 2005 Published by Elsevier SAS. doi:10.1016/j.jbspin.2005.03.021