The assessment of presenteeism and activity impairment in Behçet’s syndrome and recurrent aphthous stomatitis: a multicentre study

Abstract

Objective To evaluate key factors for Presenteeism and Activity impairment in multinational patients with Behçet’s syndrome (BS) and recurrent aphthous stomatitis (RAS). Methods In this cross-sectional study, 364 BS patients from Jordan, Brazil, the United Kingdom and Turkey and 143 RAS patients from the United Kingdom and Turkey were included. Work Productivity Activity Impairment (WPAI) scale was used for Presenteeism and Activity impairment. Mediation analyses were performed to evaluate both direct and indirect causal effects. Results Presenteeism score was higher in active patients with genital ulcers and eye involvement as well as patients with comorbidities and current smokers than the others in BS (p< 0.05). In RAS, Presenteeism score was elevated by oral ulcer activity in the direct path (p= 0.0073) and long disease duration as a mediator in the indirect path (p= 0.0191). Patients with active joint involvement had poor scores in Absenteeism, Presenteeism, Overall impairment and Activity impairment compared with those of inactive patients (p < 0.05). Using mediation analysis, the Activity impairment score was directly mediated by joint activity (p = 0.0001) and indirectly mediated through oral ulcer-related pain in BS (p = 0.0309). Conclusion In BS, Presenteeism was associated with disease activity, presence of comorbidities and being a current smoker, whereas in RAS, Presenteeism was associated with oral ulcer activity and increased length of the disease. Moreover, Activity impairment was adversely affected by joint activity and oral ulcer related pain in BS. Patients need to be empowered by using appropriate treatment strategies in their working environment and daily life.

Does decision tree analysis predict oral ulcer activity-related factors in patients with Behçet's syndrome?

“…The results of the study showed that oral ulcer activity was associated with genital ulcers, cutaneous manifestations and musculoskeletal activity as well as with female gender, receiving Non-IS treatment protocol and being non-smoker. These findings are consistent with previous studies that have shown co-occurrence of mucocutaneous symptoms and musculoskeletal manifestations in the heterogenous spectrum of the disease (13,(44)(45)(46), especially in patients having oral ulcer activity related factors in BS (10,11).…”

“…Oral ulcers are common clinical manifestations lead to poor oral functions and impaired daily life in patients with BS. Oral ulcer is the key manifestation of the disease activity and may also be an indicator for the development of major organ involvement in BS (4,(6)(7)(8)(9)(10)(11)(12)(13). The oral environment is a dynamic ecosystem that is an integral part of overall health.…”

A cross‐sectional study on activity impairment in primary Sjogren's syndrome

“…These analyses helped to understand hidden relations on outcome variables in clinical practice (Mumcu et al, 2020;Yay et al, 2019). In previous studies, increase in oral ulcer-related pain in Behcet's disease (Karacayli et al, 2021) and HADS-D score in Takayasu arteritis (Erdal et al, 2021) are found to be significant mediators for WPAI-Daily activity impairment. Furthermore, the relationships identified through these mediation and moderation analyses offer important insights to rheumatologists and oral medicine specialists seeking to create personalized treatment strategies for daily activity impairment and empower patients with pSS.…”

“…However due to a limited number of employed patients (n = 6), subgroups of WPAI absenteeism, presenteeism and overall impairment were not evaluated in this study. The WPAI scale was validated in previous studies for patients with BD (Karacayli et al, 2021;Mumcu et al, 2017), RAS (Karacayli et al, 2021) and TAK (Erdal et al, 2021) in our previous studies.…”

“…Besides, a moderator variable (W) is defined as a third variable affecting the direction of the relationship between the dependent (Y) and independent variable (X) (Hayes, 2018; Hayes & Rockwood, 2017). In our previous studies, these analyses are used to understand associations among symptoms in Behcet's disease (BS) (Karacayli et al, 2021; Mumcu et al, 2020; Yay et al, 2019) and Takayasu arteritis (TAK) (Erdal et al, 2021). The aim of this cross‐sectional study was to show relations between activity impairment and salivary gland involvement for patient empowerment in patients with primary Sjogren's syndrome (pSS).…”