title: "Better but not best": a qualitative exploration of the experiences of occupational gain for people with inflammatory arthritis receiving anti-TNFα treatment.
abstract: OBJECTIVE
  To investigate whether patients with improved clinical markers during their anti-TNFα treatment experience improvements in their functional and psychological ability to undertake activities.
  
  
  METHODS
  Patients receiving anti-TNFα treatment for rheumatoid arthritis (RA) or ankylosing spondylitis (AS) were recruited from outpatient clinics in East Anglia and North West England. Purposive sampling recruited variety in demographic and treatment experiences. Data were collected through in-depth qualitative interviews and analysed using an interpretive phenomenological framework. Twenty-seven patients were recruited; 19 with RA, eight with AS, and aged from 21 to 73 years.
  
  
  RESULTS
  While people generally experienced an improvement in their functional ability, known as occupational gain, they continued to experience difficulties through previous biomechanical damage, continuing symptoms of inflammatory arthritis, or concerns about anti-TNFα treatment. These disruptions affected how participants retained or regained employment. Lack of healthcare support, including an absence of occupational therapy intervention, resulted in people testing new boundaries through a process of unsupported trial and error.
  
  
  CONCLUSIONS
  Occupational gain was not maximised for people on anti-TNFα treatment. Improved referral pathways to occupational therapy could facilitate the management of continuing functional difficulties, thereby maximising the benefit of treatment to people with inflammatory arthritis.
authors: School of Rehabilitation Sciences, The Queen's Building, University of East Anglia , Norwich , UK and.
authors: Margaret A
authors: MA
authors: McArthur
authors: Linda
authors: L
authors: Birt
authors: Lynne
authors: L
authors: Goodacre
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D004651:Employment; D004739:England; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D013167:Spondylitis, Ankylosing / Q000188:drug therapy / Q000534:rehabilitation*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha
keywords: Anti-TNFα; drug therapy; employment; function; rheumatic diseases