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.
Sokka
Tuulikki
T
Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland. tuulikki.sokka@ksshp.fi
Kautiainen
Hannu
H
Pincus
Theodore
T
Verstappen
Suzanne M M
SM
Aggarwal
Amita
A
Alten
Rieke
R
Andersone
Daina
D
Badsha
Humeira
H
Baecklund
Eva
E
Belmonte
Miguel
M
Craig-Müller
Jürgen
J
da Mota
Licia Maria Henrique
LM
Dimic
Alexander
A
Fathi
Nihal A
NA
Ferraccioli
Gianfranco
G
Fukuda
Wataru
W
Géher
Pál
P
Gogus
Feride
F
Hajjaj-Hassouni
Najia
N
Hamoud
Hisham
H
Haugeberg
Glenn
G
Henrohn
Dan
D
Horslev-Petersen
Kim
K
Ionescu
Ruxandra
R
Karateew
Dmitry
D
Kuuse
Reet
R
Laurindo
Ieda Maria Magalhaes
IM
Lazovskis
Juris
J
Luukkainen
Reijo
R
Mofti
Ayman
A
Murphy
Eithne
E
Nakajima
Ayako
A
Oyoo
Omondi
O
Pandya
Sapan C
SC
Pohl
Christof
C
Predeteanu
Denisa
D
Rexhepi
Mjellma
M
Rexhepi
Sylejman
S
Sharma
Banwari
B
Shono
Eisuke
E
Sibilia
Jean
J
Sierakowski
Stanislaw
S
Skopouli
Fotini N
FN
Stropuviene
Sigita
S
Toloza
Sergio
S
Valter
Ivo
I
Woolf
Anthony
A
Yamanaka
Hisashi
H
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