title: Does disease activity at start of biologic therapy influence work-loss in RA patients?
abstract: OBJECTIVE
  To compare work-loss in RA patients starting their first biologic with high vs moderate disease activity.
  
  
  METHODS
  We identified all RA patients aged 20-63 years in the Swedish Biologics Register who started their first biologic 2007-09 with high disease activity (DAS28 >5.1; n = 868) or moderate disease activity (DAS28 3.2-5.1; n = 854). Work days lost, defined as sick leave and disability pension days from the Swedish Social Insurance Agency, were assessed over 5 years after first bio-start. We estimated between-group mean differences adjusted for age, sex, calendar year, education level, disease duration, comorbidities and work-loss the month before bio-start.
  
  
  RESULTS
  During 5 years after anti-TNF start, mean monthly work days lost declined from 16.0 to 9.2 (42%; P < 0.001) in patients with high disease activity at baseline and from 12.0 to 7.2 (40%; P < 0.001) in patients with moderate disease activity, with no between-group difference (adjusted mean difference 0.81; 95% CI - 0.44, 2.05). Accumulated 5-year work-loss was, however, higher in the high activity group (724 vs 548 days; adjusted mean difference 70; 95% CI 20, 120), but after stratification on baseline disability pension status, no differences in accumulated work-loss were detected.
  
  
  CONCLUSIONS
  Substantial work-loss was seen in both patients with high and patients with moderate disease activity at anti-TNF start, with a 5-year decline in mean monthly work days lost by ∼40% in both groups and no between-group difference. Accumulated work-loss over 5 years was higher in the high-activity group, which may be explained by differences in baseline disability pension status.
authors.affiliation: Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, torolofsson@hotmail.com.
authors.forename: Tor
authors.initials: T
authors.lastname: Olofsson
authors.affiliation: Clinical Epidemiology Unit.
authors.forename: Kari
authors.initials: K
authors.lastname: Johansson
authors.affiliation: Clinical Epidemiology Unit.
authors.forename: Jonas K
authors.initials: JK
authors.lastname: Eriksson
authors.affiliation: CLINTRID, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm and.
authors.forename: Ronald
authors.initials: R
authors.lastname: van Vollenhoven
authors.affiliation: CLINTRID.
authors.forename: Heather
authors.initials: H
authors.lastname: Miller
authors.affiliation: Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Orthopedics, Department of Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Ingemar F
authors.initials: IF
authors.lastname: Petersson
authors.affiliation: Clinical Epidemiology Unit, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm and.
authors.forename: Johan
authors.initials: J
authors.lastname: Askling
authors.affiliation: Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund.
authors.forename: Martin
authors.initials: M
authors.lastname: Neovius
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000534:rehabilitation*; D001688:Biological Products / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D018868:Insurance, Disability / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D018582:Sick Leave / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha
keywords: biologics; disability pension; disease activity; rheumatoid arthritis; sick leave