title: Interventions aiming to reduce early retirement due to rheumatic diseases.
abstract: BACKGROUND
  Aging of the population and early retirement translates into productivity losses to society. Persistence of working life is crucial to counteract this sustainability issue faced by western countries. Musculoskeletal and rheumatic diseases (RD) may cause work disability and early exit from work, including early retirement. The objective of this article is to review the current knowledge about interventions aiming to reduce early retirement due to RD.
  
  
  METHODS
  We searched PubMed and The Cochrane Library for studies either in English or Portuguese between January 2000 and June 2016 that evaluated the impact of interventions targeting early retirement in RD patients still at work. We also searched for grey literature from Portuguese institutional repositories.
  
  
  RESULTS
  We identified several published studies testing pharmacologic and non-pharmacologic vocational rehabilitation interventions. None was specifically identified for Portugal. The general low quality of the literature and its inconsistency makes it unfeasible to draw definitive conclusions. However, some broad recommendations might be outlined. An effective intervention must: 1) act upon different levels (e.g. RD patient, workplace), involving several stakeholders (e.g. rheumatologists, occupational physicians, employers); 2) prioritize the right patients (e.g. more disabling RD); and 3) consider the patients' role, for instance by including an element of patient education and support. Despite the lack of good quality evidence on this field, there seems to be a growing interest in the international scientific community with several ongoing studies promoting such interventions. This promising data will be very useful to set up effective policies.
  
  
  CONCLUSIONS
  This article summarizes the current knowledge about the impact of interventions to avoid or mitigate early retirement in RD patients. It highlights the demand for further research and it also contributes to aware decision-makers about the relevance of this topic, particularly in Portugal.
authors.affiliation: Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
authors.forename: Pedro Almeida
authors.initials: PA
authors.lastname: Laires
authors.affiliation: Catolica Lisbon School of Business and Economics, Lisbon, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Gouveia
authors.affiliation: NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Lisboa, Portugal.
authors.forename: Helena
authors.initials: H
authors.lastname: Canhão
mesh_terms: D000367:Age Factors; D006801:Humans; D012179:Retirement / Q000706:statistics & numerical data*; D012216:Rheumatic Diseases / Q000628:therapy*