OP-0144 –
Which Patients Stop Working Because of RA? Results from an Inception Cohort with 10 Yr Follow-up
Young, Norton, Stafford, Rajagopal, Prouse, Williams, Devlin, Gough; St. Albans, United Kingdom
Objectives
Work disability accounts for the largest individual and societal costs of RA. Thus, maintaining the ability to work is an important goal of early aggressive RA therapy. However, decisions to discontinue employment are complex and not well understood in early RA patients.
Methods
Patients enrolled in the Early RA Study (ERAS) cohort, a group defined by RA of less than two years duration at enrollment recruited through out-patient rheumatology clinics in 9 districts in the United Kingdom, were queried at baseline and follow-up regarding socioeconomic factors and baseline employment and work activities. In addition, RA disease activity and severity measures and measures of comorbidity were collected at baseline and follow-up. Predictors of job discontinuation were determined among those employed at baseline.
Results
Among the 791 enrolled subjects with at least 10 years of follow-up (female 70%; mean age 56 years, RF positive in 66%), 411 (52%) were gainfully employed at baseline, 25% full-time. The activities of the majority of those employed were sedentary, with manual or semi-manual labor reported in only 38% of those employed. The remaining 48% of enrolled patients were either retired or working at home at the time of enrollment.
After 10 years of follow-up among those employed at baseline, 51% were still working in the same job and 41% had quit working or retired. RA was the reason for work discontinuation in 60%, other reasons than RA (such as reaching retirement age) in 29%, and other comorbidity in 6%. In general, patients were most likely to quit working from RA in the first years of their disease. Univariate predictors of work discontinuation included greater age at baseline, higher HAQ, higher DAS, and manual labor jobs. In multivariable models, only age, baseline DAS, and manual labor were significantly associated with work discontinuation. For the 334 enrolled patients without 10 years of follow-up, only 19% were working at baseline. Of these, 84% stopped working during follow-up. A higher percentage (38%) of these patients with reduced follow-up discontinued work due to comorbidity (28% cardiovascular and 34% respiratory).
Conclusions
Work discontinuation after RA diagnosis is primarily attributable to RA itself, occurs early after diagnosis, and varies according to specific predictors, including the type of labor.
Editorial Comment
These findings highlight the importance of early aggressive treatment in RA, as RA patients who leave the workforce may do so early and have less ability to return. It is not surprising that those with manual labor jobs may not have the same ability to continue working their jobs with active joint symptoms. However, what is often missed with this kind of investigation are the decreases in work productivity and decrease in the expected rate of job promotion and advancement that may accompany RA, both from direct factors such as difficulty with manual tasks, but also indirectly due to fatigue, missed days due to illness or attending medical appointments, and perception of having a chronic illness by superiors. Put together, decreasing work discontinuation and improving work productivity “tip-the-scales” for the cost-effectiveness of aggressive RA therapy.
