Abstract
BackgroundAxial spondyloarthritis (axSpA) frequently presents during working age and therefore impacts work participation. Biologic therapies have demonstrated a positive impact on work-related outcomes in clinical trials but real world data are limited. Therefore, we investigated the prevalence and predictors of work impairment and disability among axSpA patients attending a biologic therapy clinic.MethodsThis was a single-centre, cross-sectional study of patients with axSpA treated with biologic therapy. Work participation was assessed with the Work Productivity and Activity Impairment (WPAI) Questionnaire. Work outcomes (presenteeism, absenteeism, health-related job loss) were compared for gender, time since diagnosis, smoking status and disease outcome measures.ResultsData were available for 165 patients (mean age 47.6 years, 75% male, 21% current smokers). Mean time since diagnosis was 15.5 years and mean duration of biologic therapy 4.7 years; 19/165 (11.5%) were on a tapered-dose regimen. Occupational data were available for 144 patients amongst whom 101 (70.1%) were either currently employed or in full time education. Of those eligible to work, 17/118 (14.4%) reported inability to work due to their axSpA. Amongst those in employment, 10.8% reported absenteeism due to axSpA in the week prior to their clinic visit (mean hours missed = 13). The mean work productivity impairment was 23%. Higher disease activity (BASDAI) and markers of global health, quality of life and pain, (BAS-G, ASQoL and spinal pain VAS) were associated with axSpA related job loss, absenteeism and presenteeism.ConclusionsIn this group of axSpA patients on biologic therapy (mean age 47.6 years), almost 1 in 6 (14.4%) reported axSpA related job loss. Poor work outcomes: axSpA-related work disability, absenteeism and presenteeism were associated with poorer scores for patient-reported disease outcome measures. Strategies for enhancing work productivity should be directed towards those patients at risk of poor work outcomes. More data are needed including details of the types of work that are most difficult with axSpA.
Highlights
Axial spondyloarthritis frequently presents during working age and impacts work participation
In total, data were available for 165 Axial spondyloarthritis (axSpA) patients (123 men and 42 women)
AxSpA related job loss was significantly associated with higher scores for disease outcome measures, including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G) and Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL), after adjustment for age, gender, smoking status and number of biologic therapies prescribed
Summary
Axial spondyloarthritis (axSpA) frequently presents during working age and impacts work participation. Axial spondyloarthritis (axSpA), which frequently presents when patients are in their second or third decade of life causes back pain and disability and is recognised to impact work participation [2, 3]. Much of the research in this field has come from analysis of secondary work outcomes amongst patients participating in pharmaceutically-funded randomised controlled trials [4,5,6,7,8,9,10]. In this setting, absenteeism has been the most commonly evaluated outcome measure. We investigated the rates of work participation, productivity and absenteeism, as well as the risk factors for these poor work outcomes, amongst a group of patients with established spondyloarthritis on treatment with biologic therapies
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