Disclosures: This study was funded by the Dutch Arthritis Foundation and the European Research Council. The researchers report no additional relevant financial disclosures.
December 13, 2021
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Rheumatoid arthritis linked to 30% loss in work productivity 1 year before diagnosis

Disclosures: This study was funded by the Dutch Arthritis Foundation and the European Research Council. The researchers report no additional relevant financial disclosures.
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Patients developing rheumatoid arthritis can experience a 30% loss in work productivity a full year before the disease clinically manifests, according to data published in Rheumatology.

“As the onset of RA is generally during the midst of working life, this constitutes limitations for patients, as well as an economic burden for society,” Cleo Rogier, MD, of Erasmus University Medical Center, in Rotterdam, the Netherlands, and colleagues wrote. “The effect of RA on work participation is reflected in poorer work outcomes and patients being more likely to be forced into early retirement, indicating a partial or even non-reversible effect.”

RH1221Rogier_Graphic_01
Patients developing RA can lose work productivity months before the disease clinically manifests, with presenteeism worsening throughout the progression to diagnosis, according to data. Source: Adobe Stock.

“It is known that preceding the occurrence of clinical arthritis and RA, patients already experience pain and have functional limitations that can be as serious as in early arthritis,” they added. “However, the effect of these limitations on work-related outcomes in this pre-RA phase is unknown. Studying work participation during this symptomatic phase is important from the perspective of whether loss of work participation can be prevented by intervening earlier.”

To analyze whether work participation is impacted in patients with arthralgia during the progression to clinical RA manifestation and diagnosis, Rogier and colleagues studied three groups of individuals from Dutch longitudinal cohorts. The first group included 114 patients with arthralgia converting to RA — defined as receiving a clinical diagnosis of RA, meeting the 2010/1987 criteria and/or starting a disease-modifying antirheumatic drug — from the Leiden Clinically Suspect Arthralgia (CSA) cohort and the Rotterdam-based Sonographic Evaluation of Hands, Feet and Shoulders in Patients with Inflammatory Arthralgia (SONAR) cohort.

The second group included 57 patients with arthralgia and spontaneous symptom resolution, selected from the Leiden CSA cohort, while the last group featured 617 patients with early RA — defined as receiving a clinical diagnosis and meeting the 1987/2010 criteria — from the Leiden Early Arthritis cohort.

The researchers assessed both presenteeism — or working while sick — and absenteeism — or sick leave — in their study, using cohort data collected through the Work Productivity and Activity Impairment questionnaire and the Productivity Cost Questionnaire. Presenteeism was measured based on the degree to which health problems impacted work productivity on a scale of 0 to 10, with 0 indicating complete impairment and 10 meaning no impairment. Meanwhile, absenteeism was measured based on sick leave and the decrease in the average number of weekly working hours.

The researchers estimated patients’ ability to work 1 year prior to clinical arthritis, in absolute numbers, with the course of lost participation over time analyzed via linear mixed models within each of the three groups.

According to the researchers, mean presenteeism was seven (95% CI, 5.8-8.1) in patients with arthralgia 1 year prior to clinical RA, indicating a 30% loss of productivity. This further worsened to 6.1 (95% CI, 5.3-6.6) at RA diagnosis, representing a 39% loss in productivity. In patients with early RA, presenteeism improved over time after starting DMARDs ( = 0.052 per month; 95% CI, 0.042-0.061). Presenteeism similarly improved in patients with spontaneous arthralgia symptom resolution ( = 0.063 per month; 95% CI, 0.024-0.1).

Absenteeism, meanwhile, did not significantly change in those with arthralgia. However, absenteeism did improve in RA after DMARD initiation.

“We showed that presenteeism in the symptomatic pre-RA phase is already evident,” Rogier and colleagues wrote. “This underlines the relevance of the symptomatic pre-RA phase for patients and society. The observed reversibility in presenteeism may suggest that interventions in the phase preceding clinical arthritis (for instance, initiating DMARD treatment) could improve work participation and prevent permanent work-loss, and hence diminish the burden of RA. This should be learnt from intervention studies in arthralgia.”