title: Psychiatric and cardiovascular comorbidities as causes of long-term work disability among individuals with recent-onset rheumatoid arthritis.
abstract: OBJECTIVE
  With the ameliorating prognosis of rheumatoid arthritis (RA), the role of comorbidities as causes of work disability (WD) may increase. The aim of this study was to determine the contribution of psychiatric and cardiovascular (CV) comorbidities as the leading causes of long-term WD among patients with recent-onset RA.
  
  
  METHODS
  Between 2000 and 2007, all incident, working-age and non-retired RA patients were identified from a Finnish nationwide register. From other registers, we identified the RA patients who were granted a permanent or temporary disability pension by 31 December 2008. The incidences of disability pensions with CV diseases (ICD-10 codes I00-I99) or psychiatric disorders (F20-F69) as the leading causes were assessed and compared with the general population.
  
  
  RESULTS
  We identified a cohort of 7831 patients with RA. During follow-up, 1095 patients were granted a disability pension. After adjusting for competing risks, the 9-year cumulative incidence of WD caused by RA, a psychiatric comorbidity, or a CV disease was 11.9, 1.3, and 0.5%, respectively. Compared to the general population, the age- and sex-specific standardized incidence ratio (SIR) of WD due to psychiatric comorbidities was 0.99 [95% confidence interval (CI) 0.80-1.23] and due to CV disease 1.75 (95% CI 1.23-2.51).
  
  
  CONCLUSIONS
  In the study cohort with recent-onset RA, the 9-year cumulative incidence of disability pensions caused by psychiatric or CV comorbidities was only 11% or 4%, respectively, of that caused by RA itself. Compared to the general population, the risk of WD due to CV disease was increased.
authors.affiliation: Medical School, University of Helsinki , Helsinki , Finland.
authors.forename: A M
authors.initials: AM
authors.lastname: Kerola
authors.forename: M J
authors.initials: MJ
authors.lastname: Kauppi
authors.forename: Tvm
authors.initials: T
authors.lastname: Nieminen
authors.forename: V
authors.initials: V
authors.lastname: Rantalaiho
authors.forename: H
authors.initials: H
authors.lastname: Kautiainen
authors.forename: T
authors.initials: T
authors.lastname: Kerola
authors.forename: L J
authors.initials: LJ
authors.lastname: Virta
authors.forename: T
authors.initials: T
authors.lastname: Pohjolainen
authors.forename: K
authors.initials: K
authors.lastname: Puolakka
mesh_terms: D000293:Adolescent; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000453:epidemiology* / Q000523:psychology; D002318:Cardiovascular Diseases / Q000150:complications* / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D006233:Persons with Disabilities / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000453:epidemiology*; D008875:Middle Aged; D010415:Pensions / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult