title: Factors influencing work disability in psoriatic arthritis: first results from a large UK multicentre study.
abstract: OBJECTIVE
  The aim of this study was to determine the extent to which structural damage, clinical disease activity, demographic and social factors are associated with work disability (WD) in PsA.
  
  
  METHODS
  Four hundred patients fulfilling CASPAR (Classification Criteria for Psoriatic Arthritis) criteria for PsA were recruited from 23 hospitals across the UK. Demographic, socio-economic, work, clinical and radiographic data were collected. WD was assessed with the Work Productivity and Activity Impairment Specific Health Problem (WPAI-SHP) questionnaire reporting WD as a percentage of absenteeism (work time missed), presenteeism (impairment at work/reduced effectiveness) and work productivity loss (overall work impairment/absenteeism plus presenteeism). Logistic and linear regressions were conducted to investigate associations with WD.
  
  
  RESULTS
  Two hundred and thirty-six participants of any age were in work. Absenteeism, presenteeism and productivity loss rates were 14% (s.d. 29.0), 39% (s.d. 27.2) and 46% (s.d. 30.4), respectively. Ninety-two (26%) participants of working age were unemployed. Greater age, disease duration of 2-5 years and worse physical function were associated with unemployment. Patients reported that employer awareness and helpfulness exerted a strongly positive influence on remaining in employment. Higher levels of global and joint-specific disease activity and worse physical function were associated with greater levels of presenteeism and productivity loss among those who remained in work.
  
  
  CONCLUSIONS
  Reduced effectiveness at work was associated with measures of disease activity, whereas unemployment, considered the endpoint of WD, was associated with employer factors, age and disease duration. A longitudinal study is under way to determine whether treatment to reduce disease activity ameliorates WD in the real-world setting.
authors.affiliation: Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK. w.tillett@nhs.net.
authors.forename: William
authors.initials: W
authors.lastname: Tillett
authors.affiliation: Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK.
authors.forename: Gavin
authors.initials: G
authors.lastname: Shaddick
authors.affiliation: Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK.
authors.forename: Ayman
authors.initials: A
authors.lastname: Askari
authors.affiliation: Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK.
authors.forename: Annie
authors.initials: A
authors.lastname: Cooper
authors.affiliation: Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Creamer
authors.affiliation: Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK.
authors.forename: Gavin
authors.initials: G
authors.lastname: Clunie
authors.affiliation: Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Helliwell
authors.affiliation: Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK.
authors.forename: Lesley
authors.initials: L
authors.lastname: Kay
authors.affiliation: Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Korendowych
authors.affiliation: Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Lane
authors.affiliation: Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Packham
authors.affiliation: Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK.
authors.forename: Ragai
authors.initials: R
authors.lastname: Shaban
authors.affiliation: Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK.
authors.forename: Lyn
authors.initials: L
authors.lastname: Williamson
authors.affiliation: Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK. Royal National Hospital for Rheumatic Diseases, Department of Mathematics, University of Bath, Bath, Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire, Department of Rheumatology, Royal Hampshire County Hospital, Winchester, Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol, Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Haywood Rheumatology Centre, Stoke-on-Trent, Department of Rheumatology, Queen Alexandra Hospital, Portsmouth, Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon and University of Bath, Department of Pharmacy and Pharmacology, Bath, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: McHugh
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015535:Arthritis, Psoriatic / Q000503:physiopathology / Q000523:psychology; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014478:Unemployment / Q000523:psychology; D006113:United Kingdom; D014938:Work Capacity Evaluation; D055815:Young Adult
keywords: employment; psoriatic arthritis; work disability