Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA study.
BACKGROUND
Work 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.


METHODS
The 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.


RESULTS
At 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.


CONCLUSIONS
Work 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.
Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland. tuulikki.sokka@ksshp.fi
Tuulikki
T
Sokka
Hannu
H
Kautiainen
Theodore
T
Pincus
Suzanne M M
SM
Verstappen
Amita
A
Aggarwal
Rieke
R
Alten
Daina
D
Andersone
Humeira
H
Badsha
Eva
E
Baecklund
Miguel
M
Belmonte
Jürgen
J
Craig-Müller
Licia Maria Henrique
LM
da Mota
Alexander
A
Dimic
Nihal A
NA
Fathi
Gianfranco
G
Ferraccioli
Wataru
W
Fukuda
Pál
P
Géher
Feride
F
Gogus
Najia
N
Hajjaj-Hassouni
Hisham
H
Hamoud
Glenn
G
Haugeberg
Dan
D
Henrohn
Kim
K
Horslev-Petersen
Ruxandra
R
Ionescu
Dmitry
D
Karateew
Reet
R
Kuuse
Ieda Maria Magalhaes
IM
Laurindo
Juris
J
Lazovskis
Reijo
R
Luukkainen
Ayman
A
Mofti
Eithne
E
Murphy
Ayako
A
Nakajima
Omondi
O
Oyoo
Sapan C
SC
Pandya
Christof
C
Pohl
Denisa
D
Predeteanu
Mjellma
M
Rexhepi
Sylejman
S
Rexhepi
Banwari
B
Sharma
Eisuke
E
Shono
Jean
J
Sibilia
Stanislaw
S
Sierakowski
Fotini N
FN
Skopouli
Sigita
S
Stropuviene
Sergio
S
Toloza
Ivo
I
Valter
Anthony
A
Woolf
Hisashi
H
Yamanaka
D001172:Arthritis, Rheumatoid / Q000503:physiopathology*; D016208:Databases, Factual; D004185:Disability Evaluation; D006233:Persons with Disabilities; D004651:Employment / Q000706:statistics & numerical data*; D005221:Fatigue; D005260:Female; D014943:Global Health; D006304:Health Status; D006801:Humans; D018868:Insurance, Disability / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009787:Occupational Medicine / Q000706:statistics & numerical data; D010146:Pain; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014938:Work Capacity Evaluation