title: Effect of anti-TNF and conventional synthetic disease-modifying anti-rheumatic drug treatment on work disability and clinical outcome in a multicentre observational cohort study of psoriatic arthritis.
abstract: To determine the effect of medical treatment on work disability in patients with active PsA in a real-world setting.
  
  
  
  Four hundred patients with active PsA commencing or switching to anti-TNF or conventional synthetic DMARD (csDMARD) were recruited to a multicentre UK prospective observational cohort study. Work disability was measured using the work productivity and activity-specific health problem instrument and peripheral joint activity was measured with the disease activity in PsA composite measure.
  
  
  
  Four hundred patients were recruited, of whom 229 (57.25%) were working (of any age). Sixty-two patients of working age (24%) were unemployed. At 6 months there was a 10% improvement in presenteeism ( P = 0.007) and a 15% improvement in work productivity ( P = 0.001) among working patients commenced on csDMARDs ( n = 164) vs a larger and more rapid 30% improvement in presenteeism ( P < 0.001) and 40% improvement in work productivity ( P < 0.001) among those commenced on anti-TNF therapy ( n = 65). Clinical response was poor among patients commenced on a csDMARD ( n = 272), with an 8.4 point improvement in disease activity in PsA ( P < 0.001) vs those commenced on anti-TNF therapy ( n = 121), who had a 36.8 point improvement ( P < 0.001).
  
  
  
  We report significant and clinically meaningful improvements in both work disability and clinical outcomes after commencement of anti-TNF therapy in a real-world setting. Improvements in all outcomes among those commencing csDMARDs were slower and of a smaller magnitude.
authors.affiliation: Department of Rheumatology, Royal National Hospital for Rheumatic Diseases.|Department of Pharmacy and Pharmacology.
authors.forename: William
authors.initials: W
authors.lastname: Tillett
authors.affiliation: Department of Mathematics, University of Bath, Bath.
authors.forename: Gavin
authors.initials: G
authors.lastname: Shaddick
authors.affiliation: Department of Mathematics, University of Bath, Bath.
authors.forename: Amelia
authors.initials: A
authors.lastname: Jobling
authors.affiliation: Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire.
authors.forename: Ayman
authors.initials: A
authors.lastname: Askari
authors.affiliation: Department of Rheumatology, Queen Alexandra Hospital, Portsmouth.
authors.forename: Annie
authors.initials: A
authors.lastname: Cooper
authors.affiliation: Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol.
authors.forename: Paul
authors.initials: P
authors.lastname: Creamer
authors.affiliation: Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge.
authors.forename: Gavin
authors.initials: G
authors.lastname: Clunie
authors.affiliation: Department of Rheumatology, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Helliwell
authors.affiliation: Department of Rheumatology, Royal National Hospital for Rheumatic Diseases.
authors.forename: Jana
authors.initials: J
authors.lastname: James
authors.affiliation: Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne.
authors.forename: Lesley
authors.initials: L
authors.lastname: Kay
authors.affiliation: Department of Rheumatology, Royal National Hospital for Rheumatic Diseases.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Korendowych
authors.affiliation: Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Lane
authors.affiliation: Department of Rheumatology, Haywood Rheumatology Centre, Stoke-on-Trentand.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Packham
authors.affiliation: Department of Rheumatology, Queen Alexandra Hospital, Portsmouth.
authors.forename: Ragai
authors.initials: R
authors.lastname: Shaban
authors.affiliation: Department of Mathematics, University of Bath, Bath.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Thomas
authors.affiliation: Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon, UK.
authors.forename: Lyn
authors.initials: L
authors.lastname: Williamson
authors.affiliation: Department of Rheumatology, Royal National Hospital for Rheumatic Diseases.|Department of Pharmacy and Pharmacology.
authors.forename: Neil
authors.initials: N
authors.lastname: McHugh
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D001685:Biological Factors / Q000627:therapeutic use*; D006233:Persons with Disabilities; D004526:Efficiency; D000068800:Etanercept / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000188:drug therapy; D000069597:Presenteeism / Q000706:statistics & numerical data; D011446:Prospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014478:Unemployment / Q000706:statistics & numerical data; D014938:Work Capacity Evaluation
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D001685:Biological Factors; D014409:Tumor Necrosis Factor-alpha; C529000:golimumab; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: anti-TNF; csDMARDs; outcomes research; psoriatic arthritis; work disability