Which patients stop working because of rheumatoid arthritis? Results of five years' follow up in 732 patients from the Early RA Study (ERAS)

Abstract

Objectives: To assess the occurrence and prognostic factors for the ability to maintain paid work in patients with rheumatoid arthritis (RA). Setting: Inception cohort of patients with RA recruited from rheumatology departments in nine NHS Hospital Trusts in England. Patients: All consecutive patients with RA of less than two years' duration, before any second line (disease modifying) drug treatment, and followed up for five years. Methods: Clinical, laboratory, and radiological assessments, and all treatments were recorded prospectively using a standardised format at presentation and yearly. Outcome measures: Changes in, and loss of paid work by five years' follow up. Results: 732 patients completed the five year follow up. 353/721 (49%) were gainfully employed at the onset of RA, 211 (60%) were still working at five years, 104 (29%) stopped because of the disease, and 31 (9%) retired for reasons other than RA. Work disability at five years was more likely in manual workers (odds ratio (OR) 2.3, 95% confidence interval (CI) 1.4 to 3.8) and worse baseline Health Assessment Questionnaire (HAQ>1.5, OR 2.26, 95% CI 1.38 to 3.7). In combination with other baseline variables (erythrocyte sedimentation rate, sex, age of onset, and radiological erosions), employment outcome was predicted in 78% using multivariate analysis. Conclusions: Nearly half of the patients with RA were in paid employment at onset, work disability was an adverse outcome for a third of these patients by five years, and manual work and high baseline HAQ were important predictors for this. These details are likely to be useful to clinicians, health professionals, and patients in order to plan medical, orthopaedic, and remedial treatments in early RA. Future disease modifying treatments could be compared with this cohort of patients who were treated with conventional second line drugs.

Longitudinal study of negative workplace events among employed rheumatoid arthritis patients and healthy controls

“…For example, we also found that work autonomy, functional status, pain, and social support were linked to outcomes (3)(4)(5)(6)(7)(8)11,13). However, unlike other studies, we did not find that depressive symptoms were associated with work outcomes (12), possibly because the prevalence of depressive symptoms in our samples was low.…”

“…Job loss also has been associated with greater disease severity measured by physical examination, laboratory tests, radiographs, functional status, and symptoms such as pain and fatigue (6 -9,13-16). As expected, more physical requirements, such as lifting and precision writing, and less work autonomy, such as less control over the daily workload, pace of work, and work hours, are also related to job loss (3,(7)(8)(9)17).…”

“…Most studies have focused on job loss and vocational rehabilitation and have identified predictors of adverse work outcomes, including older age, less education, less social support, not wanting to work, multiple social roles, and more depressive symptoms (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Job loss also has been associated with greater disease severity measured by physical examination, laboratory tests, radiographs, functional status, and symptoms such as pain and fatigue (6 -9,13-16).…”

Effect of the early use of the anti–tumor necrosis factor adalimumab on the prevention of job loss in patients with early rheumatoid arthritis

“…The substantial impact of rheumatoid arthritis (RA) on work disability and job loss has recently received considerable attention (1,2) and represents a significant economic burden (3)(4)(5). Recent developments in therapies targeted against tumor necrosis factor (TNF) have changed the approach to RA treatment by rapidly controlling the disease, particularly in early disease (6,7) when the opportunity to prevent structural damage is critical.…”

Participation in work in early rheumatoid arthritis: a qualitative interview study interpreted in terms of the ICF

“…Even early in the disease process this is common despite early pharmacological interventions with disease-modifying anti-rheumatic drugs (DMARD) [1][2][3][4][5]. Work disability in RA is dependent on many factors, such as disease activity, activity limitations and environmental demands [6][7][8]. Also, from qualitative approaches, it is known that patients with RA experience that participation in work is influenced by symptoms such as morning stiffness, fatigue and pain as well as environmental factors such as support from employers and colleagues [9].…”