title: Longitudinal study of the impact of incident organ manifestations and increased disease activity on work loss among persons with systemic lupus erythematosus.
abstract: OBJECTIVE
  There is increasing evidence of the impact of systemic lupus erythematosus (SLE) on employment, but few studies have had sufficient sample size and longitudinal followup to estimate the impact of specific manifestations or of increasing disease activity on employment.
  
  
  METHODS
  Data were derived from the University of California, San Francisco, Lupus Outcomes Study, a longitudinal cohort of 1,204 persons with SLE sampled between 2002 and 2009. Of the 1,204 persons, 484 were working at baseline and had at least 1 followup interview. We used the Kaplan-Meier method to estimate the time between onset of thrombotic, neuropsychiatric, or musculoskeletal manifestations, or of increased disease activity, and work loss. We used Cox proportional hazards regression to estimate the risk of work loss associated with the onset of specific manifestations, the number of manifestations, and increased activity, with and without adjustment for sociodemographic, employment, and SLE duration characteristics.
  
  
  RESULTS
  By 4 years of followup, 57%, 34%, and 38% of those with thrombotic, musculoskeletal, and neuropsychiatric manifestations, respectively, had stopped working, as had 42% of those with increased disease activity. On a bivariable basis, the risk of work loss was significantly higher among persons ages 55-64 years and those with increased disease activity and each kind of manifestation. In multivariable analysis, older age, shorter job tenure, thrombotic and musculoskeletal manifestations, greater number of manifestations, and high levels of activity increased the risk of work loss.
  
  
  CONCLUSIONS
  Incident thrombosis and musculoskeletal manifestations, multiple manifestations, and increased disease activity are associated with the risk of work loss in SLE.
authors: Rosalind Russell Medical Research Center for Arthritis and Institute for Health Policy Studies, University of California, San Francisco, USA. ed.yelin@ucsf.edu
authors: Edward
authors: E
authors: Yelin
authors: Chris
authors: C
authors: Tonner
authors: Laura
authors: L
authors: Trupin
authors: Stuart A
authors: SA
authors: Gansky
authors: Laura
authors: L
authors: Julian
authors: Patricia
authors: P
authors: Katz
authors: Jinoos
authors: J
authors: Yazdany
authors: Rachel
authors: R
authors: Kaiser
authors: Lindsey A
authors: LA
authors: Criswell
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D017281:Cost of Illness; D003863:Depression / Q000453:epidemiology*; D004185:Disability Evaluation; D004651:Employment; D005260:Female; D006304:Health Status; D006801:Humans; D007221:Industry; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D008181:Lupus Nephritis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology*; D012720:Severity of Illness Index; D018582:Sick Leave; D013927:Thrombosis / Q000453:epidemiology*; D055815:Young Adult