Identifying Persons with Axial Spondyloarthritis At Risk of Poor Work Outcome: Results from the British Society for Rheumatology Biologics Register

Abstract

Objective.First, to test the hypothesis that, among working patients with axial spondyloarthritis (axSpA), those who report issues with reduced productivity at work (presenteeism) are at higher risk of work absence (absenteeism), and patients who report absenteeism are at higher risk of subsequently leaving the workforce. Second, to identify characteristics of workers at high risk of poor work outcome.Methods.The British Society for Rheumatology Biologics Register in Ankylosing Spondylitis has recruited patients meeting Assessment of Spondyloarthritis international Society criteria for axSpA from 83 centers. Data collection involved clinical and patient-reported measures at recruitment and annually thereafter, including the Work Productivity and Activity Impairment scale. Generalized estimating equations were used to identify factors associated with poor work outcomes.Results.Of the 1188 participants in this analysis who were working at recruitment, 79% reported some presenteeism and 19% some absenteeism in the past week owing to their axSpA. Leaving employment was most strongly associated with previous absenteeism (RR 1.02 per % increase in absenteeism, 95% CI 1.01–1.03), which itself was most strongly associated with previous presenteeism, a labor-intensive job, and peripheral joint involvement. High disease activity, fatigue, a labor-intensive job, and poorer physical function were all independently associated with future presenteeism.Conclusion.Clinical and patient-reported factors along with aspects of work are associated with an increased risk of axSpA patients having a poor outcome in relation to work. This study has identified modifiable factors as targets, facilitating patients with axSpA to remain productive at work.

Work Productivity is Associated With Disease Activity and Functional Ability in Chinese Patients With Axial Spondyloarthritis Using A Smart-Phone Management System: A Prospective Cohort Study

“…1187 patients were included in our study. We found the employment rate in patients with axSpA in China is 66.81% is higher than the rate in England, which was 62% [17]. The patients in our research were much younger than those in the English study.…”

A cross‐sectional study on factors associated with poor work outcomes in patients with axial spondyloarthritis in Singapore

“…Our findings concur with studies done in Western populations. Studies in axSpA and ankylosing spondylitis populations have previously shown that increased disease activity was associated with presenteeism and activity impairment . Other studies have demonstrated that decreased physical function was associated with work productivity loss and activity impairment, and poorer quality of life with absenteeism, presenteeism, work productivity loss and activity impairment …”

“…The type of employment and its impact on work outcomes were not evaluated in this study. This would be important to evaluate in future as work nature does have negative impact on work outcomes in axSpA, particularly blue collar workers with manual work . In addition, further studies to look at reasons on unemployment for patients with axial SpA would be important.…”

“…There have been studies showing disease activity and physical function were associated with poor work outcomes in patients with axSpA. However, these studies were conducted in Western populations . To our knowledge, risk factors for poor work outcomes have not been studied in the Asian context.…”

Amongst patients taking biologic therapies for axial spondyloarthritis, which factors are associated with work non-participation?

“…In an analysis of 1188 patients who were working at the time of recruitment to a British axSpA cohort (BSRBR-AS) [21], the authors investigated whether presenteeism was associated with future absenteeism, and whether absenteeism was a risk factor for later leaving the workforce. The data supported both hypotheses.…”