SAT0586 THE INFLUENCE OF THE NEW PHARMACOLOGICAL AND NON-PHARMACOLOGICAL TREATMENTS IN AXIAL SPONDYLOARTHRITIS ON WORK PARTICIPATION: A SYSTEMATIC REVIEW

Abstract

Background: The concept of spondyloarthritis (SpA) comprises several chronic inflammatory joint diseases. SpA patients can be distinguished as patients with predominantly peripheral SpA (pSpA) or with predominantly axial SpA (axSpA) according to their clinical presentation. AxSpA primarily affects the axial skeleton and the sacroiliac joints. Within axSpA patients, a subdivision based on the radiographic changes of the sacroiliac joints can be made: radiographic axSpA, which corresponds to ankylosing spondylitis (AS), and non-radiographic axSpA (nr-axSpA). SpA occurs typically in young and professionally active patients. Since 2000, important improvements have been made in the management of SpA, both on a pharmacological (introduction of biological disease-modifying antirheumatic drugs (bDMARD)) and a non-pharmacological (holistic approach) level. As a result of early diagnosis followed by adequate treatment, the majority of patients achieve a state of clinical remission allowing them to function without significant problems. However, many of these persons still experience problems such as exclusion clauses, additional premiums and even contract refusals when contracting private insurances because mostly risk assessments are solely based on historical data. Objectives: The aim of this systematic literature review was to investigate whether the work participation in patients with axSpA has significantly improved since the introduction of the bDMARD and the non-pharmacological treatment modalities. This would provide arguments for a more accurate and updated risk assessment of the expected personal and economic incapacity of axSpA patients by private insurance companies. Methods: A systematic literature review from January 1997 until November 2017 was performed using Pubmed, Embase and Web of Science. Different search terms were used in each database: absenteeism, presenteeism, employment, sick leave, work disability and work participation. All studies assessing one of the search terms were analysed. Results: In total, 33 studies out of 603 retrieved citations were included. Overall, the results were highly heterogeneous because of the different study designs and different use of definitions regarding work outcomes. Patients with AS were significantly confronted with restrictions on work participation compared to the general population before the availability of bDMARD. In addition, our literature review showed that, since the introduction of the bDMARD and other non-pharmacological treatments, there is no evident improvement in work disability in AS patients. In contrast, a significant improvement could be observed on absenteeism, presenteeism and work productivity. Only 6 studies included patients with nr-axSpA. In most of these studies a positive tendency towards work productivity was detected. In addition, contextual factors such as the type of job, support from employers and colleagues, adjustments in workplace, and personal behaviour were identified as important factors for work participation in these patients. Conclusion: Most of the patients included in the selected studies had longstanding AS with significant structural damage. The great heterogeneity between the studies in patient populations, study design and evaluation methods impeded the formation of a uniform conclusion. However, since the introduction of the new treatment modalities, a positive tendency in work productivity in AS and nr-axSpA patients could be observed. More observational, cross-sectional and prospective studies are needed - especially in nr-axSpA patients - to evaluate the effect of both pharmacological and non-pharmacological treatment on the work outcome in SpA patients. Disclosure of Interests: None declared