title: Factors associated with absenteeism, presenteeism and activity impairment in patients in the first years of RA.
abstract: OBJECTIVE
  To understand the impact of the early years of RA on all aspects of work productivity, and determine how this is related to clinical markers. Previous research on work productivity has examined predominantly early retirement and absenteeism. The impact of reduced work performance (presenteeism) and activity impairment is less well understood in early RA populations.
  
  
  METHODS
  Working patients enrolled in an RA inception cohort were recruited into a nested study. A questionnaire incorporating the Work Productivity and Activity Impairment (WPAI) instrument was administered with a number of clinical outcomes, including the Multidimensional Health Assessment Questionnaire (MD-HAQ) and scales for pain, fatigue and patient assessment of disease patient global assessment (PtGA).
  
  
  RESULTS
  Analysis included 150 RA patients, with the mean age at onset being 48 years (s.d. 10 years) and disease duration from symptom onset being 49 months. Patients had relatively mild disease: MD-HAQ (0.6), pain (3.6), PtGA (3.6) and fatigue (4.6). Of the 92% patients working for pay, 19% reported missing work (absenteeism) in the past week due to their health, accounting for 46% of their working time. Even while at work, ∼25% of actual hours was lost due to poor health, while outside work 33% of patients' regular daily activities were prevented. In multivariate analyses, disease severity was associated with the presence of absenteeism, presenteeism and activity impairment. Patients able to self-schedule their work had lower presenteeism and activity impairment.
  
  
  CONCLUSIONS
  Productivity loss is common in patients in the first years of RA who are in paid work and was associated with work characteristics and adverse clinical outcomes.
authors.affiliation: Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver.
authors.forename: Nick
authors.initials: N
authors.lastname: Bansback
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.forename: David
authors.initials: D
authors.lastname: Walsh
authors.forename: Patrick
authors.initials: P
authors.lastname: Kiely
authors.forename: Richard
authors.initials: R
authors.lastname: Williams
authors.forename: Daphne
authors.initials: D
authors.lastname: Guh
authors.forename: Aslam
authors.initials: A
authors.lastname: Anis
authors.forename: Adam
authors.initials: A
authors.lastname: Young
mesh_terms: D000041:Absenteeism; D000203:Activities of Daily Living; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000523:psychology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D004526:Efficiency; D005221:Fatigue; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009790:Occupations / Q000145:classification; D010147:Pain Measurement; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires