Abstract
IntroductionWork disability is a major consequence of rheumatoid arthritis (RA), associated not only with traditional disease activity variables, but also more significantly with demographic, functional, occupational, and societal variables. Recent reports suggest that the use of biologic agents offers potential for reduced work disability rates, but the conclusions are based on surrogate disease activity measures derived from studies primarily from Western countries.MethodsThe Quantitative Standard Monitoring of Patients with RA (QUEST-RA) multinational database of 8,039 patients in 86 sites in 32 countries, 16 with high gross domestic product (GDP) (>24K US dollars (USD) per capita) and 16 low-GDP countries (<11K USD), was analyzed for work and disability status at onset and over the course of RA and clinical status of patients who continued working or had stopped working in high-GDP versus low-GDP countries according to all RA Core Data Set measures. Associations of work disability status with RA Core Data Set variables and indices were analyzed using descriptive statistics and regression analyses.ResultsAt the time of first symptoms, 86% of men (range 57%-100% among countries) and 64% (19%-87%) of women <65 years were working. More than one third (37%) of these patients reported subsequent work disability because of RA. Among 1,756 patients whose symptoms had begun during the 2000s, the probabilities of continuing to work were 80% (95% confidence interval (CI) 78%-82%) at 2 years and 68% (95% CI 65%-71%) at 5 years, with similar patterns in high-GDP and low-GDP countries. Patients who continued working versus stopped working had significantly better clinical status for all clinical status measures and patient self-report scores, with similar patterns in high-GDP and low-GDP countries. However, patients who had stopped working in high-GDP countries had better clinical status than patients who continued working in low-GDP countries. The most significant identifier of work disability in all subgroups was Health Assessment Questionnaire (HAQ) functional disability score.ConclusionsWork disability rates remain high among people with RA during this millennium. In low-GDP countries, people remain working with high levels of disability and disease activity. Cultural and economic differences between societies affect work disability as an outcome measure for RA.
Highlights
Work disability is a major consequence of rheumatoid arthritis (RA), associated with traditional disease activity variables, and more significantly with demographic, functional, occupational, and societal variables
The multinational QUEST-RA study provides several important observations concerning work-related outcomes in RA: (a) work disability rates remain high among patients with RA during this millennium; (b) major differences are seen in the proportion of women and men working at the onset of RA in different countries; (c) people continue working in low-gross domestic product (GDP) countries with levels of disease activity as high as or higher than those of work-disabled people with RA in high-GDP countries; and (d) in both high-GDP and low-GDP nations, the most significant identifier of work disability is the Health Assessment Questionnaire (HAQ) functional disability score
Identifiers of work disability A series of logistic regressions was performed to analyze the independent capacity of age, sex, education, Rheumatoid factor (RF), radiographic erosions, HAQ physical function, erythrocyte sedimentation rate (ESR), and swollen joint count using 28 joints (SJC28) to identify people who reported that they were work-disabled due to RA (Table 4)
Summary
Work disability is a major consequence of rheumatoid arthritis (RA), associated with traditional disease activity variables, and more significantly with demographic, functional, occupational, and societal variables. Recent reports suggest that the use of biologic agents offers potential for reduced work disability rates, but the conclusions are based on surrogate disease activity measures derived from studies primarily from Western countries. Work disability is a major consequence of rheumatoid arthritis (RA) [1,2,3,4]. The availability of biologic agents during the past decade has led to expectations of reduced work disability rates in RA [7], according to observations in clinical trials [8,9,10,11,12]. Possible explanations are that the timing of biologic agents after joint damage is seen may be too late in many cases or that the use of biologic agents is unusual in many countries for financial reasons or both [17]
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