Work participation in patients with axial spondyloarthritis: high prevalence of negative workplace experiences and long-term work impairment

Abstract

IntroductionAxial spondyloarthritis (axSpA) is a chronic inflammatory disease that typically affects people in their second and third decades of life, which are important years for establishing a professional career. We aim to study outcomes of work participation (WP) and their associations with demographic and clinical confounders, in addition to prevalence of negative workplace experiences in axSpA.MethodsIn total, 770 patients with axSpA participated in the multicentre, observational ATTENTUS–axSpA survey in Germany. Demographic information, clinical parameters and patient-related outcomes (including disease activity and function) with a focus on WP were prospectively recorded.ResultsA high prevalence of negative workplace experiences was reported among the 770 patients analysed. Overall, 23.4% of patients were not employed and 6.5% received disability pensions. Current work cessation was prevalent in 120 patients, and 28 of those were out of work for 10 years or longer. Of the 590 currently employed patients, 31.9% reported absenteeism and 35.9% reported presenteeism for >1 month within the past year. Multivariate logistic regression identified low disease activity (Bath Ankylosing Spondylitis Disease Activity Index), better physical function (Bath Ankylosing Spondylitis Functional Index) and better global functioning (Assessment of SpondylAarthritis International Society–Health Index) as the main predictors for unimpaired WP (n=242). Importantly, biological treatment, disease duration, age, sex, education level and body mass index were not reliable predictors.DiscussionDespite improvements in pharmacological treatment options, we still observed substantially impaired WP in patients with axSpA. These data emphasise the high unmet need for targeted strategies to provide improved medical and social care.

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“…Notably, this was not improved with biological treatment. 32 However, this lack of improvement is not the case in all studies, with one systematic literature review finding overall work productivity to be improved to a greater extent for axSpA patients who received biological treatment than placebo. 33 In addition, a cross-sectional questionnaire of patients with axSpA and psoriatic arthritis found that, despite biologic treatment, a high proportion of patients had abnormal sleep behaviour which was associated with impaired HRQoL and a higher rate of depressive symptoms.…”

“…Notably, this was not improved with biological treatment. 32 However, this lack of improvement is not the case in all studies, with one systematic literature review finding overall work productivity to be improved to a greater extent for axSpA patients who received biological treatment than placebo. 33 …”

“…Further, the 1-year study period may have been too short to observe improvements in work productivity scores for some patients, particularly for absenteeism, where workplace circumstances and support play a role in return to work. 32 …”

“…Further, the 1-year study period may have been too short to observe improvements in work productivity scores for some patients, particularly for absenteeism, where workplace circumstances and support play a role in return to work. 32 Although the recommended instrument for HRQoL in the ASAS-OMERACT core outcome set is the ASAS Health Index, 35 36 this study used ASQoL, a tool with similar content to the ASAS Health Index, 37 which was specifically developed for use in patients with ankylosing spondylitis and has since been validated in patients with nr-axSpA. 28 29 This allowed for the disease-specific impacts of axSpA on overall HRQoL to be measured in this current study.…”

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“…Patients with active spondyloarthritis have high rates of general hospitalization for various reasons, including emergency room visits, outpatient visits, and investigations [11]. Patients with psoriatic arthritis have more frequent and longer periods of temporary disability compared to their peers [12]; up to 74.1% of patients with active axial spondyloarthritis face employment problems [13], and almost a quarter (23.4%) are unable to work fully due to illness [14]. Persistent disability, according to various sources, occurs in 13-45% of patients with axial spondyloarthritis [4], and in 16-39% in psoriatic arthritis patients [15].…”