Work Disability In Patients Research Articles

Anxiety and Work Disability in Patients With Immune-Mediated Inflammatory Diseases: A Cross-Sectional Study From a Single Center.

Immune-mediated inflammatory diseases (IMIDs) are chronic diseases that are associated with an inflammatory process with unclear etiology and occur in genetically predisposed individuals. In this study, inflammatory bowel disease (IBD) and rheumatic disease (RD) were examined. The aim of the research is to evaluate the relationship between IMID and state anxiety and work impairment in patients. A cross-sectional study was conducted in an outpatient clinic for rheumatology and gastroenterology at an Italian university hospital. A total of 476 patients (261 IBD and 215 RD) were considered. Patients diagnosed with IBD demonstrated significantly higher levels of anxiety, encompassing both trait and state anxiety, compared to those with RD ( p <.001). While trait anxiety exhibited a modest positive correlation with work productivity loss ( r =.163; p =.046), activity impairment showed a positive correlation with both state anxiety ( r =.243; p <.001) and trait anxiety ( r =.206; p =.002). The impact of anxiety on job performance and daily activities should not be underestimated, as it may elevate the risk of unemployment and absenteeism and lead to increased societal costs.

Impact of Continuous Positive Airway Pressure Termination on Permanent Work Disability in Obstructive Sleep Apnea: A French Nationwide ALASKA Database Analysis.

Rationale: Three-year continuous positive airway pressure (CPAP) therapy termination rates are up to 50%, and therapy termination is associated with higher all-cause mortality and incident cardiovascular event risk. Objectives: This study investigated the impact of CPAP therapy termination in the first year on long sick leave leading to permanent work disability in patients with obstructive sleep apnea based on data from the Nationwide Claims Data Lake for Sleep Apnoea (ALASKA). Methods: French national health insurance reimbursement system data were analyzed for all adults with OSA aged ≤62 years who started CPAP therapy in France in 2015 and 2016. CPAP therapy termination was defined as the cessation of CPAP reimbursements triggered by the respiratory physician or sleep specialist in charge of follow-up. Individuals who terminated therapy were compared with those who continued to use CPAP. The primary outcome was sick leave ultimately leading to permanent work disability. A multivariable Fine and Gray model, adjusted for age, sex, cardiovascular and metabolic comorbidities, depression, and CPAP prescriber clinical specialty was used to assess the risk of long-term sick leave leading to permanent work disability over 3 years' follow-up. Results: The analysis included 174,270 individuals (median age, 52.0 yr [interquartile range, 44.0-57.0 yr]; 67.5% male). The 1-year CPAP therapy termination rate was 22.3%. The proportion of individuals with long-term sick leave leading to permanent work disability was significantly higher in the CPAP termination versus continuation group (0.60% vs. 0.52%; P = 0.042). In an adjusted multivariable Cox model, CPAP termination was associated with an increased risk of permanent work disability (hazard ratio, 1.21; 95% confidence interval [CI], 1.04-1.41; P = 0.01), primarily in the subgroup aged >55 years (hazard ratio, 1.41; 95% CI, 1.06-1.87; P = 0.02). Conclusions: These real-world data from a comprehensive, unbiased database highlight the potential occupational impact of CPAP therapy termination.

Association of Sociodemographic Factors and Prolonged Recovery Time from Work Disability in Patients with Cervical Sprain in Obregon City, Mexico

Background: Work disability is a medical certification that considers both physical factors and psychophysical conditions of the worker and work conditions. Exceeding the recovery time means a prolonged disability. The most frequent pathologies that incapacitate are cervical injuries (30%), with cervical sprain being the most common. Objective: To determine the association between sociodemographic factors and prolonged time of recovery from disability in patients with a diagnosis of cervical sprain grade 1 and 2 in Obregon City, Mexico. Methods: An analytic cross-sectional study was conducted in the family medicine unit 1 from Obregon City, Mexico. Medical records of 376 disabled workers due to grade 1 and 2 cervical sprain were reviewed. In the bivariate analysis, odds ratio and Chi-Square with a confidence interval of 95% was implemented, a p &lt;0.05 was considered significant Results: Of the 376 disabilities due to general illness, 144(46.6%) were prolonged and 165(53.4%) not prolonged. In disabilities for work risk, 44(65.7%) were prolonged and 23(34.3%) not prolonged, this difference was significative (p=0.005). Conclusions: The variable more associated with prolonged disability wastype of disability (work risk).

Poremećaji vidne funkcije i radna invalidnost oboljelih od dijabetesa i hipertenzije

Objective. Diabetes mellitus and arterial hypertension are chronic, mass non-communicable diseases that are global health problems with characteristics of epidemiology where complications of these diseases are the common reason for visual handicap and disability in the work productive population. The primary aim of this paper was to analyze the frequency of visual dysfunction, and behavioral habits in diabetic and hypertensive patients and the second aim was to analyze the occurrence of work disability in patients with these diseases. Methods. The research is a cross-sectional study made in two Health Centers in the City of Eastern Sarajevo in a period of July 2018 to July 2019 (12 months). 192 patients with diabetes and 100 patients with hypertension were selected using the random sampling method. A special questionnaire was created for this purpose, and statistic analysis was made by SPSS (IBM, Chicago version 19). Statistical significance was tested with ch2 test. Results. Diabetic patients significantly have more visual disturbances than hypertensive patients according to subjective assessment (ch2=14.21, p&lt; 0.001). Worsening of visual acuity is presented more in diabetic than in hypertensive patients (ch2=6.17, p&lt;0.001). There is no significant difference in behavioral habits between diabetic and hypertensive patients for smoking (ch2=1.778, p=0.411) and alcohol consumption.( ch2=2.158, p=0.142). Patients with diabetes are more frequent in the status of work disability than those with hypertension (ch2=13,46, p&lt;0,001). Conclusion. Mass non-communicable diseases are a common cause of visual dysfunction. Diabetes mellitus is the main reason for visual disability in the adult population from the region of Eastern Sarajevo. Behavioral habits like smoking and alcohol consumption have a serious impact on the prognosis of those patients.

Prognostic factors for work disability in patients with chronic widespread pain and fibromyalgia: protocol for a cohort study

IntroductionThe association between chronic widespread pain (CWP) and disability is well established. Although research support large interindividual differences in functional outcomes, limited studies are available on the socio-economic consequences of...

Work Loss in Patients With Celiac Disease: A Population-based Longitudinal Study

Celiac disease (CD) affects around 1% of the population worldwide. Data on work disability in patients with CD remain scarce. We estimated work loss in patients with CD, including its temporal relationship to diagnosis. Through biopsy reports from Sweden's 28 pathology departments, we identified 16,005 working-aged patients with prevalent CD (villus atrophy) as of January 1, 2015, and 4936 incident patients diagnosed with CD in 2008 to 2015. Each patient was matched to up to 5 general-population comparators. Using nationwide social insurance registers, we retrieved prospectively recorded data on compensation for sick leave and disability leave to assess work loss in patients and comparators. In 2015, patients with prevalent CD had a mean of 42.5 lost work days as compared with 28.6 in comparators (mean difference, 14.7; 95% confidence interval [CI], 13.2-16.2), corresponding to a relative increase of 49%. More than one-half of the work loss (60.1%) in patients with CD was derived from a small subgroup (7%), whereas 75.4% had no work loss. Among incident patients, the annual mean difference between patients and comparators was 8.0 days (range, 5.4-10.6 days) of lost work 5 years before CD diagnosis, which grew to 13.7 days (range, 9.1-18.3 days) 5 years after diagnosis. No difference in work loss was observed between patients with or without mucosal healing at follow-up. Patients with CD lost more work days than comparators before their diagnosis, and this loss increased after diagnosis. Identifying patients with an increased risk of work loss may serve as a target to mitigate work disability, and thereby reduce work loss, in patients with CD.

P605 Development and validation of an objective disability index for Inflammatory Bowel Disease patients (ODIBD)

Abstract Background Inflammatory Bowel Disease (IBD) can be a cause of disability. To date, the scores that evaluate disability in IBD patient use mainly subjective criteria. The aim of this study was to develop and validate an index of disability in IBD based on objective, measurable criteria. Methods IBD patients from the Catalan and Spanish Crohn and Colitis Associations volunteered to fulfill an online self-administered survey. Demographic, clinical, and therapeutic variables were collected. They also informed on whether they have a recognized disability and whether they receive a work disability pension. Patients were divided into a training and validation set. In the training set, different multivariate analyses were carried out to evaluate objective variables related to having a recognized work disability, a general disability or a moderate or severe degree of disability. The score was elaborated with the statistically or clinically significant variables present in the multivariate analyses. The ROC curves for predicting general and work disability were calculated. Results 981 valid surveys were included. Sixty six percent of the patients were women, mean age was 40.9 years and 59.3% had Crohn’s disease. Of these patients, 85 (9.1%) had a recognized work disability and 429 (45.9%) had a degree of recognized general disability. The results of the multivariate analyses are shown in table 1. Eight variables were selected to develop the inflammatory bowel disease objective work disability index (ODIBD) (table 2). Each variable was scored one point to calculate the final index. The AUROC of the index in the training group was 0.76 for work disability and 0.71 for general disability. The AUROC of the index in the validation group was 0.83 for work disability and 0.67 for general disability (fig1). Conclusion The ODIBD may be useful score to objectively assess of work disability in patients with IBD.

Prevalence, Indirect Costs, and Risk Factors for Work Disability in Patients with Crohn's Disease at a Tertiary Care Center in Rio de Janeiro.

Crohn's disease (CD) can lead to work disability with social and economic impacts worldwide. In Brazil, where its prevalence is increasing, we assessed the indirect costs, prevalence, and risk factors for work disability in the state of Rio de Janeiro and in a tertiary care referral center of the state. Data were retrieved from the database of the Single System of Social Security Benefits Information, with a cross-check for aid pension and disability retirement. A subanalysis was performed with CD patients followed up at the tertiary care referral center using a prospective CD database, including clinical variables assessed as possible risk factors for work disability. From 2010 to 2018, the estimated prevalence of CD was 26.05 per 100,000 inhabitants, while the associated work disability was 16.6%, with indirect costs of US$ 8,562,195.86. Permanent disability occurred more frequently in those aged 40 to 49years. In the referral center, the prevalence of work disability was 16.7%, with a mean interval of 3years between diagnosis and the first benefit. Risk factors for absence from work were predominantly abdominal surgery, anovaginal fistulas, disease duration, and the A2 profile of the Montreal classification. In Rio de Janeiro, work disability affects one-sixth of CD patients, and risk factors are associated with disease duration and complications. In the context of increasing prevalence, as this disability compromises young patients after a relatively short period of disease, the socioeconomic burden of CD is expected to increase in the future.

Work disability in rheumatic diseases: Baseline results from an inception cohort

We aimed to characterize work disability in patients with newly diagnosed rheumatic diseases and compare work characteristics between patients with rheumatic diseases and controls without rheumatic diseases at diagnosis. Patients with inflammatory arthritis (IA) and osteoarthritis (OA), surrogates for autoimmune and non-autoimmune rheumatic diseases, respectively, and controls of working age were surveyed at diagnosis. Patients with rheumatic diseases who were employed before symptom onset were characterized as having work disability if they reported reduced work ability and productivity while remaining in the same job as before symptom onset, changed to a less demanding job or stopped working/retired. Work characteristics at diagnosis were compared between rheumatic diseases patients and controls. The unemployment rate before symptom onset was lower in patients with IA (20%) compared to patients with OA (32%). Among patients with IA and OA who were employed before symptom onset, 59% and 43% reported work disability, respectively (P=.04). The unemployment rate at diagnosis was comparable in patients with IA (26%) and higher in patients with OA (38%) compared to controls (29%). Employed patients with IA and OA, when compared with controls, reported poorer work ability (score: 37 vs 39 vs 41, P<.01; proportion with poor/moderate work ability: 48% vs 33% vs 21%, P<.01) and greater work productivity loss (score: 32 vs 29 vs 17, P<.01) at diagnosis. Rheumatic diseases impose significant work disability at diagnosis, highlighting the need for identification and interventions targeting work disability early in the course of disease.

Work disability in a multi-ethnic Malaysian systemic lupus erythematosus cohort: A cross-sectional study.

To determine the prevalence of work disability (WD) among patients with systemic lupus erythematosus (SLE) and its associated factors. This was a cross-sectional study involving SLE patients aged 18-56years from Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Employment history was obtained from clinical interviews. WD was defined as unemployment, interruption of employment or premature cessation of employment due to SLE at any time after the diagnosis. SLE disease characteristics, presence of organ damage and Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SLEDAI) flare index were determined from the medical records. Self-reported quality of life (QoL) was performed using the Medical Outcomes Study Short Form-36 (SF-36). Demographic factors, disease characteristics, and QoL were compared between patients with and without WD using statistical analyses. A total of 215 patients were recruited and the majority were Malay (60.5%), followed by Chinese (33.5%), Indian (4.5%) and others (n=4, 1.9%). The prevalence of WD was 43.2% (n=93) with 22.3% (n=48) patients were unemployed at the time of study. Over half the patients with WD (n=51, 54.8%) had onset of disability at <5years from diagnosis. Patients with WD had significantly lower health-related QoL. The independent factors associated with WD were SLEDAI score at diagnosis, frequency of flare, Systemic Lupus International Collaborating Clinics score, being married, had lower education and lupus nephritis. We found a high rate of WD in patients with SLE and it was significantly associated with SLE-related factors, in particular higher disease activity, presence of renal involvement and organ damage.

Risk factors for subsequent work disability in patients with acute myocardial infarction.

Scientific knowledge on risk factors for work disability in terms of long-term sickness absence (SA) and disability pension (DP) following acute myocardial infarction (AMI) is limited. The study aimed to investigate socio-demographic, work-related and medical characteristics as risk factors for long-term SA (>90 days) and DP in patients with a first AMI. This is a population-based cohort study of 8199 individuals aged 19-60 years who had a first AMI during 2008-10 and were alive 30 days after AMI. Univariate and multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) with regard to long-term SA and DP with a 3-year follow-up were estimated by Cox regression. We found a higher risk of long-term SA and DP after AMI in women, those with lower education and previous SA (range of HRs: 1.29-7.34). Older age and being born in non-European countries were associated with a 2- to 3-fold higher risk of DP. Moreover, ST-elevation myocardial infarction (STEMI), musculoskeletal and common mental disorders (CMDs) were risk factors for long-term SA and DP, while diabetes mellitus and stroke were associated with a higher risk of DP (range of HRs: 1.12-2.98). Coronary artery bypass grafting (CABG) compared with percutaneous coronary intervention was associated with a 2-fold higher risk of work disability. Older women, those with lower education and non-European immigrants had a higher risk of work disability after AMI, particularly permanent work disability. STEMI, CABG, diabetes mellitus, stroke, musculoskeletal disorders and CMDs provide important clinical information for work disability after AMI.

Predictors of Impaired Quality of Life and Work Disability in Patients with Systemic Diseases

Background: Systemic diseases are heterogeneous diseases that represent one of the leading causes of disability with high rates of premature mortality and significant social costs. Methods: We conducted a cross-sectional study at an Internal Medicine Department between July 2017 and September 2017. We investigated patients with systemic rheumatic diseases and we evaluated the Quality of Life (QoL). The outcomes were baseline Short Form Health Survey Physical (PCS) and Mental (MCS) Component Scores. Work disability was evaluated by the Work Productivity Assessment Impairment (WPAI) questionnaire. Correlations were calculated by the test t student or ANOVA factor test and comparison with Chi2 test and multivariate regressions were then performed. Results: Two hundred thirty five patients were included, 183 females and 52 males. The average age was 48.3 years. 47% of the population had work during the study. The most frequent diseases were: Systemic lupus erythematosus in 66 patients, Behçet syndrome in 33 patients and Sjogren primary syndrome in 27 patients. Mean PCS were 52.55 ± 17.3 and MCS scores were 47.74 ± 14.8. For the predictors related to patients: the age ((PCS:r=-0.250,p=0.000), (MCS:r=-0.160,p=0.014)), the presence of comorbidities (PCS p=0.003) and the low level of education (p=0.001) were significantly correlated with impaired QoL, the presence of profession was not significantly correlated with QoL. For the predictors related to the disease; inflammatory myositis influences most the QoL. Pulmonary manifestations (PCS:p=0.021,MCS: p=0.006) were the most correlated with impaired QoL. Multivariate analysis showed effect of age, corticosteroids therapy and work disability on MCS and the effect of age and gender on PCS. Work disability was evaluated in working patients: absenteeism was at 31.16 ± 24, productivity impairment at 48.77and systemic sclerosis was the most disease predictive of absenteeism and work disability (p=0.011). Conclusion: QoL may be severely impaired in patients suffering from systemic diseases. We studied for the first time, in Tunisia, the predictors of impaired QoL for all patients followed in our department. This measure aims to further humanize medical practice, to maintain the quality of life of patients and to take into account the individuality of each patient.

Work-disability in low back pain patients with or without surgery, and the role of social insurance regulation changes in Sweden.

The aims were to study the differences in work-disability in patients with low back pain (LBP) in relation to (i) treatment provided (non-surgical or lumber spine surgery (decompression or fusion), and (ii) two time points, i.e. before and after the social insurance regulation changes in the in 2008. All non-pensioned individuals, aged 19-60 years, living in Sweden, diagnosed with LBP in 2004-06 or 2008-10 were included (n = 153739). Hazard ratios (HRs) with 95% confidence intervals for long-term sickness absence (>90 days, LTSA) and disability pension (DP) for LBP-patients (non-surgical, decompression, fusion, both surgeries) were estimated by Cox regression compared with the matched references from the general population without LBP (n = 566008). LBP-patients had a higher risk of subsequent work-disability compared with the references before and after insurance regulation changes. LBP-patients receiving decompression surgery had similar risk for later work-disability as those treated non-surgically. However, following regulation changes, LBP-patients undergoing fusion surgery had higher risk estimates of both LTSA (HR: 3.3) and DP (HR: 4.8) than patients treated non-surgically (HR: LTSA 2.1; DP 2.5) or with decompression (HR: LTSA 2.6; DP 2.1). In the adjusted models, risk estimates mainly attenuated after controlling for previous sickness absence. Risk for subsequent work-disability among LBP-patients was higher compared with people without LBP and lumbar spine surgery. Discrepancies in risk were explained by the treatment provided previous sickness absence and changes in the social insurance regulations, specifically LBP-patients treated with fusion surgery had an increased risk of subsequent work-disability after changes in regulations.

Validation of a self-reported work disability questionnaire for ulcerative colitis.

Ulcerative colitis (UC) may severely limit patients’ capacity to work. Recently, we validated a work disability questionnaire (WDQ) for Crohn disease. As UC shares clinical characteristics with Crohn disease, we hypothesized that the questionnaire might also be useful for UC. The study was aimed to validate the WDQ for use in UC.Consecutive patients with UC (n = 142, 67 women; age 48 ± 1) completed the UC-WDQ and the inflammatory bowel disease questionnaire-9 (IBDQ-9), and EuroQoL-5D quality-of-life questionnaires. Validation of the UC-WDQ included an assessment of its construct validity, including: discriminant validity, convergent validity, and reproducibility (test–retest). We also calculated the intraclass correlation and the Cronbach alpha.1.Discriminant validity: Mean UC-WDQ scores were 12.8 ± 4.4 (remission phase) and 17.2 ± 6.1 (with clinical activity) (P < .05).2.Convergent validity: The correlations of UC-WDQ were r = 0.74 (P < .001) with IBDQ, r = 0.44 (P < .01) with disease activity, r = 0.56 (P < .01) with EuroQoL-5D, and r = 0.60 (P < .01) with the EuroQoL-5D visual scale.3.Reproducibility:Test–retest reproducibility: UC-WDQ scores obtained after a 2-week interval were similar (15.8 vs 15.1), (r = 0.91, P < .01).Intraclass correlation was 0.93 (95% confidence interval 0.92–0.95).Cronbach alpha was 0.94.The UC-WDQ is a valid and reliable tool for measuring work disability in patients with UC.

Prognostic factors for return to work and work disability among colorectal cancer survivors; A systematic review.

BackgroundColorectal cancer is diagnosed progressively in employed patients due to screening programs and increasing retirement age. The objective of this study was to identify prognostic factors for return to work and work disability in patients with colorectal cancer.MethodsThe research protocol was published at PROSPERO with registration number CRD42017049757. A systematic review of cohort and case-control studies in colorectal cancer patients above 18 years, who were employed when diagnosed, and who had a surgical resection with curative intent were included. The primary outcome was return to work or work disability. Potentially prognostic factors were included in the analysis if they were measured in at least three studies. Risk of bias was assessed according to the QUality In Prognosis Studies tool. A qualitative synthesis analysis was performed due to heterogeneity between studies. Quality of evidence was evaluated according to Grading of Recommendation Assessment, Development and Evaluation.ResultsEight studies were included with a follow-up period of 26 up to 520 weeks. (Neo)adjuvant therapy, higher age, and more comorbidities had a significant negative influence on return to work. A previous period of unemployment, extensive surgical resection and postoperative complications significantly increased the risk of work disability. The quality of evidence for these prognostic factors was considered very low to moderate.ConclusionHealth care professionals need to be aware of these prognostic factors to select patients eligible for timely intensified rehabilitation in order to optimize the return to work process and prevent work disability.

Work disability in soldiers with posttraumatic stress disorder, posttraumatic embitterment disorder, and not-event-related common mental disorders.

Posttraumatic mental disorders may occur with different affect qualities. Best known is posttraumatic stress disorder (PTSD), a conditioned anxiety reaction with intrusions. Another event-related mental disorder is posttraumatic embitterment (PTED), characterized by affect of embitterment and thoughts of revenge, occurring after an event deeply hurting basic beliefs. Knowing about associated disability is important for treatment and sociomedical decisions. This is the first study to explore work-disability in patients with PTSD, PTED, and not-event-related common mental disorder (CMD). In this observational study, 101 soldiers (85% men, 31 years, 50% experienced expedition abroad) with different mental disorders were investigated concerning common mental disorders (MINI) and accompanying work capacity impairment (Mini-ICF-APP). Interviews were conducted by a state-licensed psychotherapist with expertise in sociomedical description of (work) capacity impairment. Patients with PTSD, PTED, and other CMD were compared concerning their degrees and pattern of work capacity impairment. PTSD patients (n = 23) were more strongly impaired in mobility as compared to patients with other CMD (n = 64) or PTED. Patients with PTED (n = 14) were more impaired in interactional capacities (contacts with others, group integration) as compared to patients with other CMD or PTSD. PTSD patients need support to improve mobility in (work-relevant) traffic situations. Apart from this, they are not specifically more or less impaired than patients with other CMD. PTED patients should get attention concerning their interactional problems as these may disturb esprit de corps, which is an essential requirement for service in the armed forces. (PsycINFO Database Record

Prognostic Factors for Permanent Work Disability in Patients With Rheumatoid Arthritis Who Received Combination Therapy of Conventional Synthetic Disease-Modifying Antirheumatic Drugs: A Retrospective Cohort Study.

There is limited information about the factors related with the development of long-term permanent work disability (PWD) in rheumatoid arthritis (RA) treated with a combination of conventional synthetic disease-modifying antirheumatic drugs (cs-DMARDs). The aim of this study was to evaluate incidence and factors associated with the development of PWD in RA treated with combination therapy using conventional synthetic cs-DMARDs. We assessed in multivariate models the effect of clinical and demographic factors in the development of PWD in a long-term retrospective cohort of 180 workers with RA who were treated with a combination of cs-DMARDs. Incidence rates of PWD were 2.2% at 1 year, 7.7% at 5 years, 24.9% at 10 years, 34.9% at 15 years, and 45% at 20 years. In the adjusted Cox regression analysis, factors associated with PWD development were the first failure with combination of cs-DMARDs (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.05-5.46; P = 0.03), poor functioning at time of cohort onset (HR, 2.2; 95% CI, 1.05-4.70; P = 0.03), and requirement for joint replacement (HR, 3.3; 95% CI, 1.28-8.79; P = 0.01). Around 25% of workers with combination therapy with cs-DMARDs developed PWD in 10 years following the diagnosis of RA. Some factors increase the risk of disability. Permanent work disability generates a relevant society burden and increases health care costs. Therefore, indicators predicting failure of combination therapies with cs-DMARDs might provide clinicians of useful tools for modifying treatments avoiding the disease progression.

A Treat-to-Target Strategy Preserves Work Capacity in a Rheumatoid Arthritis Inception Cohort Treated With Combination Conventional DMARD Therapy.

Quantification of work disability in patients with early rheumatoid arthritis (RA) receiving conventional DMARDs according to a treat-to-target strategy. This is a retrospective cohort analysis of RA patients who received combination conventional DMARDs, escalated to achieve DAS28(ESR) remission and completed an annual work and arthritis questionnaire. Random effect mixed modeling was used to assess associations between average hours worked per week (HWPW), and baseline prognostic factors. HWPW were compared with matched population averages. Cox proportional hazards modeling was employed to evaluate associations between permanent loss of employment and treatment response, disease and demographic factors. Work data from 135 patients working at baseline and 137 working at any point followed for up to 14 years (range 1-14) were available for analysis. The mean age was 45 years, 70% were female, and 70% and 68% were seropositive for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP), respectively. Men worked more hours than women; there was a highly significant association between working hours lost and increasing age (0.28 hours, P = 0.04) and female gender (11.92 hours, P < 0.001). HWPW were maintained over the study time comparable to the general population (loss of 0.78 vs. 0.24 HWPW). EULAR good responders at 6 months were more likely to be working at 10 years compared to those with moderate/no response. Permanent loss of employment and baseline age were strongly associated for anti-CCP positive participants (P = 0.04). Treat-to-target combination conventional DMARD therapy maintains work capacity, particularly in good responders, comparable to the general population. Improving treatment response in moderate/no responders early in disease may increase work retention.

Effect of anti-TNF and conventional synthetic disease-modifying anti-rheumatic drug treatment on work disability and clinical outcome in a multicentre observational cohort study of psoriatic arthritis.

To determine the effect of medical treatment on work disability in patients with active PsA in a real-world setting. Four hundred patients with active PsA commencing or switching to anti-TNF or conventional synthetic DMARD (csDMARD) were recruited to a multicentre UK prospective observational cohort study. Work disability was measured using the work productivity and activity-specific health problem instrument and peripheral joint activity was measured with the disease activity in PsA composite measure. Four hundred patients were recruited, of whom 229 (57.25%) were working (of any age). Sixty-two patients of working age (24%) were unemployed. At 6 months there was a 10% improvement in presenteeism ( P = 0.007) and a 15% improvement in work productivity ( P = 0.001) among working patients commenced on csDMARDs ( n = 164) vs a larger and more rapid 30% improvement in presenteeism ( P < 0.001) and 40% improvement in work productivity ( P < 0.001) among those commenced on anti-TNF therapy ( n = 65). Clinical response was poor among patients commenced on a csDMARD ( n = 272), with an 8.4 point improvement in disease activity in PsA ( P < 0.001) vs those commenced on anti-TNF therapy ( n = 121), who had a 36.8 point improvement ( P < 0.001). We report significant and clinically meaningful improvements in both work disability and clinical outcomes after commencement of anti-TNF therapy in a real-world setting. Improvements in all outcomes among those commencing csDMARDs were slower and of a smaller magnitude.

Longterm Work Productivity Costs Due to Absenteeism and Permanent Work Disability in Patients with Early Rheumatoid Arthritis: A Nationwide Register Study of 7831 Patients.

To estimate the development and potential disproportional distribution of longterm productivity costs (PC) and their determinants leading to work absenteeism and permanent work disability in working-aged patients with early rheumatoid arthritis (RA). A cohort of subjects with early RA was created by identifying the new cases of RA from the national drug reimbursement register that had been granted a special reimbursement for their antirheumatic medications for RA from 2000-2007. The dataset was enriched by cross-linking with other national registries detailing work absenteeism days and permanent disability pensions. In the base case, the human capital approach was applied to estimate PC based on subjects' annual number of absenteeism days and incomes. Hurdle regression analysis was applied to study the determinants of PC. Among the 7831 subjects with early RA, the mean (bootstrapped 95% CI) annual PC per person-observation year was €4800 (4547-5070). The annual PC declined after the first year of RA diagnosis, but increased significantly in subsequent years. In addition, the PC was heavily disproportionally concentrated in a small fraction of patients with RA, because only around 20% of patients accounted for the majority of total annual PC. The initiation of active drug treatment during the first 3 months after RA diagnosis significantly reduced the cumulative PC when compared with no drug treatment. The longterm PC increased significantly in parallel with years elapsing after RA diagnosis. Further, the majority of these PC are incurred by a small proportion of patients.