AB0207 VOLATILITY OF WORK PARTICIPATION DOMAINS AFTER A FLARE OF RHEUMATOID ARTHRITIS UNDER TREAT-TO-TARGET THERAPY

Abstract

BackgroundRheumatoid arthritis (RA) is one of the most common diseases worldwide with a need for rehabilitation despite recent advantages in pharmacological treatment options. Furthermore, data show a numerical increase in years of life with disability in RA patients in Germany from 1990 to 2017. Limitations in work participation (WP) also remain highly prevalent.ObjectivesWe investigate the development of different domains of WP (unimpaired WP, presenteeism, absenteeism, and no employment) at the patient level under drug therapy over 12 months to understand the impact of pharmacological treatment.MethodsThe multicenter ERFASS study prospectively enrolled seropositive RA patients with an active flare of disease initiating treat-to-target (T2T) drug therapy over 12 months [1]. Patients were enrolled between 01/2018 and 12/2019. We examine the different domains of WP in working-age patients (18-65 years) excluding students and old-age pensioners using the WPAI of patients with a complete dataset at all three measurement time points (month 0, 6 and 12). Disease activity was measured using the DAS28.ResultsA total of 122 patients (73.0% female) with a mean age of 52.8 years (SD: 8.5) were included. Disease activity according to DAS28-CRP decreased significantly over the course of the study from 4.2 at baseline to 2.5 at month 12 (p<.001). The proportion of non-working patients increased numerically over the course of the study from 30.3% to 36.1% (p=0.085). The proportion of patients with absenteeism decreased significantly from 22.1% at baseline to 12.3% at month 12 (p=0.033). There were small changes in presenteeism (month 12: 35.2%; p=0.086). The proportion of patients with unrestricted WP increased significantly from 10.7% at baseline to 16.4% at month 12 (p<0.001) (Table 1). Graph 1 shows the quantitatively relevant changes in WP over the course of the study in a sankey diagram. The group of not working patients mainly gains growth from the group of patients with absenteeism. Patients with unimpaired WP proportionally become more because patients with presenteeism or absenteeism at baseline improve their WP to unimpaired WP. However, we detected a substantial proportion of patients with initially unimpaired WP facing impairments as most likely presenteeism during T2T. At all measure points we see the most substantial fluctuations in patients with presenteeism and absenteeism.ConclusionBesides good therapy response in terms of disease activity, we demonstrate that the majority of unemployed patients during an acute disease flare does not find their way back into the work force within twelve months of T2T pharmaceutical treatment. The greatest improvements in WP were observed in patients with absenteeism at baseline. Although the proportion of patients without limitations in WP increased significantly, it remained at a low level at the end of the study. Our data provide an understanding of the development of the different domains of WP in patients after a flare of RA which helps to tailor occupational rehabilitation concepts.Reference[1]Hoeper, J. R., et al. (2021). Effect of nurse-led care on outcomes in patients with APCA/RF-positive rheumatoid arthritis with active disease undergoing treat-to-target. RMD Open.Table 1.Demographics, disease activity and domains of WP during study course.BaselineMonth 6Month 12p-valueAge years (SD)52.8 (8.5)Gender (female) n (%)89 (73.0)DAS28-CRP (mean)4.22.82.5<.001Not working n (%)37 (30.3)40 (32.8)44 (36.1).085Absenteeism n (%)27 (22.1)16 (13.1)15 (12.3).033Presenteeism only n (%)45 (36.9)50 (41.0)43 (35.3).086Unimpaired WP n (%)13 (10.7)16 (13.1)20 (16.4)<.001Graph 1.Development of domains of WP in a Sankey diagram. The width of the arrows equivalents the proportion of patients changing between groups.Acknowledgements:NIL.Disclosure of InterestsSara Eileen Meyer: None declared, Juliana Rachel Hoeper: None declared, Birte Luise Haegermann: None declared, Ioana Iliadis: None declared, Torsten Witte Grant/research support from: Abbvie, Novartis, Kai Kahl: None declared, Kirsten Hoeper Speakers bureau: Abbvie, Novartis, Galapagos, Consultant of: Abbvie, Novartis, Galapagos, Dirk Meyer-Olson Speakers bureau: Abbvie, Amgen, Berlin Chemie, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Cellgene, Celltrion, Chugai, Fresenius Kabi, Galapagos, GSK, Jansen Cilag, Lilly, Medac, Merck Sharp & Dome, Mylan, Novartis, Pfizer, Sandoz Hexal, Sanofi und UCB, Consultant of: Abbvie, Amgen, Berlin Chemie, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Cellgene, Celltrion, Chugai, Fresenius Kabi, Galapagos, GSK, Jansen Cilag, Lilly, Medac, Merck Sharp & Dome, Mylan, Novartis, Pfizer, Sandoz Hexal, Sanofi und UCB.