title: Work status and its determinants among patients with systemic sclerosis: a systematic review.
abstract: OBJECTIVE
  To describe work status and factors associated with work disability (WD) in patients with SSc.
  
  
  METHODS
  A systematic search strategy in various electronic databases from 1990 to 2011 was performed. All clinical studies concerning SSc patients containing quantitative information on work status and/or factors associated with WD were selected. Extracted were study characteristics, data on work status and/or factors associated with WD. The methodological quality was evaluated in three quality aspects (selection bias, information bias and statistical analysis bias). A best evidence synthesis was employed to analyse the association between potential determinants and WD.
  
  
  RESULTS
  Twelve studies, described in 13 papers, including 2758 SSc patients were selected. The methodological quality of one study was high. Employment rates varied between 11 and 82% after an average disease duration ranging from 2.5 to 14 years. There was moderate evidence for an association between more functional disability, more disease-specific symptoms and poorer quality of life on one side and presence of WD on the other. There was moderate evidence for the absence of an association between WD and age, sex and disease subset. Inconsistent evidence was seen for an association between WD and education and disease duration.
  
  
  CONCLUSIONS
  WD is a major consequence of the disease in patients with SSc and is associated with more functional disability, more disease-specific symptoms and poorer quality of life. This emphasizes the need for research into interventions to prevent or reduce WD in patients with SSc, especially in those with a poorer health status.
authors.affiliation: Department of Rheumatology (C1-R), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. a.a.schouffoer@lumc.nl
authors.forename: Anne A
authors.initials: AA
authors.lastname: Schouffoer
authors.forename: Jan W
authors.initials: JW
authors.lastname: Schoones
authors.forename: Caroline B
authors.initials: CB
authors.lastname: Terwee
authors.forename: Theodora P M
authors.initials: TP
authors.lastname: Vliet Vlieland
mesh_terms: D004185:Disability Evaluation; D004651:Employment; D006304:Health Status; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000523:psychology / Q000534:rehabilitation*; D011788:Quality of Life; D012720:Severity of Illness Index; D012959:Socioeconomic Factors