title: Sick leave and disability pension before and after initiation of antirheumatic therapies in clinical practice.
abstract: OBJECTIVE
  To investigate sick leave and disability pension in rheumatoid arthritis (RA) in relation to the initiation of biological and non-biological antirheumatic therapies in clinical practice.
  
  
  METHODS
  Patients aged 19-60 years initiating non-biological mono (n=2796) or combination disease-modifying antirheumatic drug (DMARD) therapy (n=973), or biological agents (n=4787) were identified in the Swedish Rheumatology Quality Register between 1999 and 2007. Sick leave and disability pension data (1995-2010) were retrieved from national registers.
  
  
  RESULTS
  During the year before the start of mono DMARD, combination DMARD and biological treatment, 10%, 12% and 43% of patients received disability pension benefits, respectively. The corresponding combined annual sick leave and disability pension days were 78 (54+25), 132 (105+27) and 190 (79+111). Irrespective of treatment type, initiators were characterised by a history of increasing sick leave and disability pension. Treatment start was associated with a break in this trajectory: sick leave decreased while disability pension increased, resulting in a net stabilisation of total days. Higher levels of days on sick leave and disability pension at treatment start were observed in patients initiating biologics in 1999 (236 days/year) compared with 2007 (150 days/year; p<0.001), but the trajectory thereafter remained largely similar and contrasted markedly with the level in the general population.
  
  
  CONCLUSIONS
  Sick leave and disability pension increased rapidly before the initiation of antirheumatic therapy, which was associated with a halt but not a reversal of this development. Work ability is a metric of importance for clinical practice, signalling large remaining needs in the RA population, and the need for intervention earlier in the disease process.
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. martin.neovius@ki.se
authors.forename: M
authors.initials: M
authors.lastname: Neovius
authors.forename: J F
authors.initials: JF
authors.lastname: Simard
authors.forename: L
authors.initials: L
authors.lastname: Klareskog
authors.forename: J
authors.initials: J
authors.lastname: Askling
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000534:rehabilitation; D001688:Biological Products / Q000627:therapeutic use; D017281:Cost of Illness; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D006801:Humans; D008875:Middle Aged; D010415:Pensions / Q000706:statistics & numerical data*; D012042:Registries; D018582:Sick Leave / Q000706:statistics & numerical data*; D013548:Sweden; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products