Identification of modifiable work-related factors that influence the risk of work disability in rheumatoid arthritis.

OBJECTIVE To define work-related factors associated with increased risk of work disability (WD) in people with rheumatoid arthritis (RA). METHODS Questionnaires were mailed to all RA patients who used a province-wide arthritis treatment program between 1991 and 1998 (n = 1,824). The association between risk factors and WD (defined as no paid work due to RA for at least 6 months) was assessed using multiple logistic regression analysis, controlling for significant sociodemographic and disease-related variables. RESULTS Of the original 1,824 patients, 581 were eligible and responded to the questionnaire. Work survival analysis revealed a steady rate of WD starting early, with 7.5%, 18%, and 27% work disabled at 1, 5, and 10 years, respectively. Significant determinants in multiple logistic regression were physical function (Health Assessment Questionnaire), pain (visual analog scale), and 6 work-related factors: self employment, workstation modification, work importance, family support toward employment, commuting difficulty, and comfort telling coworkers about RA. CONCLUSION Work disability occurs early in RA. Novel work-related factors were identified, which are potentially modifiable, to help RA patients stay employed.

[1]  L. D. Haber.  Disabling effects of chronic disease and impairment. , 1971, Journal of chronic diseases.

[2]  D. L. Curtis,et al.  The costs of rheumatoid arthritis. A patient-oriented study of chronic disease costs. , 1978, Arthritis and rheumatism.

[3]  H. Robinson,et al.  Patterns of work--rheumatoid arthritis. , 1979, International rehabilitation medicine.

[4]  M. Nevitt,et al.  Work disability in rheumatoid arthritis: effects of disease, social, and work factors. , 1980, Annals of internal medicine.

[5]  J. Fries,et al.  The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. , 1982, The Journal of rheumatology.

[6]  B. Larsson,et al.  The arthritic at work , 1983 .

[7]  C. Stone.  The lifetime economic costs of rheumatoid arthritis. , 1984, The Journal of rheumatology.

[8]  Robert Karasek,et al.  Job Content Questionnaire. , 1985 .

[9]  E. Yelin,et al.  Work disability among persons with musculoskeletal conditions. , 1986, Arthritis and rheumatism.

[10]  R. Walls,et al.  The Preliminary Diagnostic Questionnaire (PDQ): Functional assessment of employability. , 1987 .

[11]  E. Yelin,et al.  The work dynamics of the person with rheumatoid arthritis. , 1987, Arthritis and rheumatism.

[12]  R. Luukkainen,et al.  Work capacity of patients with inflammatory joint diseases. An eight-year follow-up study. , 1987, Scandinavian journal of rheumatology.

[13]  M. Liang,et al.  The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. , 1988, Arthritis and rheumatism.

[14]  R. Burkhauser,et al.  The importance of age, education, and comorbidity in the substantial earnings losses of individuals with symmetric polyarthritis. , 1988, Arthritis and rheumatism.

[15]  J. Fifield,et al.  Work disability among women with rheumatoid arthritis. The relative importance of disease, social, work, and family factors. , 1989, Arthritis and rheumatism.

[16]  K. Lorig,et al.  Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. , 1989, Arthritis and rheumatism.

[17]  F. Arnett.  Revised criteria for the classification of rheumatoid arthritis. , 1990, Orthopedic nursing.

[18]  Robert Karasek,et al.  Healthy Work : Stress, Productivity, and the Reconstruction of Working Life , 1990 .

[19]  U. Brodin,et al.  Auranofin treatment in early rheumatoid arthritis may postpone early retirement. Results from a 2-year double blind trial. , 1991, The Journal of rheumatology.

[20]  S. Larsson,et al.  Locomotion status and costs in destructive rheumatoid arthritis. A comprehensive study of 82 patients from a population of 13,000. , 1992, Acta orthopaedica Scandinavica.

[21]  D. Bloch,et al.  Identification of work disability in rheumatoid arthritis: physical, radiographic and laboratory variables do not add explanatory power to demographic and functional variables. , 1992, Journal of clinical epidemiology.

[22]  J. Anderson,et al.  The rapid assessment of disease activity in rheumatology (radar) questionnaire. Validity and sensitivity to change of a patient self-report measure of joint count and clinical status. , 1992, Arthritis and rheumatism.

[23]  L. Kazis,et al.  AIMS2. The content and properties of a revised and expanded Arthritis Impact Measurement Scales Health Status Questionnaire. , 1992, Arthritis and rheumatism.

[24]  K. Eberhardt,et al.  Early rheumatoid arthritis--some social, economical, and psychological aspects. , 1993, Scandinavian journal of rheumatology.

[25]  A. Antonovsky.  The structure and properties of the sense of coherence scale. , 1993, Social science & medicine.

[26]  V. H. Hildebrandt,et al.  Psychosocial factors at work and musculoskeletal disease. , 1993, Scandinavian journal of work, environment & health.

[27]  P M Bongers,et al.  Psychosocial stressors at work and musculoskeletal problems. , 1994, Scandinavian journal of work, environment & health.

[28]  F. Wolfe,et al.  The mortality of rheumatoid arthritis. , 1994, Arthritis and rheumatism.

[29]  D. Lubeck,et al.  The economic impact of arthritis. , 1995, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[30]  J. Fifield,et al.  Predictors of work disability in rheumatoid arthritis patients. A five-year followup. , 1995, Arthritis and rheumatism.

[31]  M. V. van Leeuwen,et al.  Work disability in early rheumatoid arthritis. , 1995, Annals of the rheumatic diseases.

[32]  H. Raspe,et al.  Prediction of permanent work disability in a follow-up study of early rheumatoid arthritis: results of a tree structured analysis using RECPAM. , 1996, British journal of rheumatology.

[33]  E. McIntosh,et al.  The cost of rheumatoid arthritis. , 1996, British journal of rheumatology.

[34]  E. Yelin.  The costs of rheumatoid arthritis: absolute, incremental, and marginal estimates. , 1996, The Journal of rheumatology. Supplement.

[35]  R. Meenan,et al.  Reducing work disability associated with rheumatoid arthritis: identification of additional risk factors and persons likely to benefit from intervention. , 1996, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[36]  S. Magnusson.  Treatment of rheumatoid arthritis--does it affect society's cost for the disease? , 1996, British journal of rheumatology.

[37]  D. Lubeck,et al.  Direct and indirect medical costs incurred by Canadian patients with rheumatoid arthritis: a 12 year study. , 1997, The Journal of rheumatology.

[38]  P. Hannonen,et al.  A physically demanding occupation predicts premature retirement among patients with erosive arthritis , 1998 .

[39]  K. Eberhardt,et al.  Effect of rheumatoid arthritis on work status and social and leisure time activities in patients followed 8 years from onset. , 1998, The Journal of rheumatology.

[40]  F. Wolfe,et al.  The longterm outcomes of rheumatoid arthritis: Work disability: a prospective 18 year study of 823 patients. , 1998, The Journal of rheumatology.

[41]  H. Kautiainen,et al.  Work disability in an inception cohort of patients with seropositive rheumatoid arthritis: a 20 year study. , 1999, Rheumatology.

[42]  P. Hannonen,et al.  Work disability in rheumatoid arthritis 10 years after the diagnosis. , 1999, The Journal of rheumatology.

[43]  K. Hieke,et al.  The costs of rheumatoid arthritis: an international long-term view. , 2000, Seminars in arthritis and rheumatism.

[44]  D. Symmons,et al.  The impact of rheumatoid arthritis on employment status in the early years of disease: a UK community-based study. , 2000, Rheumatology.

[45]  L. Trupin,et al.  The prevalence and impact of accommodations on the employment of persons 51-61 years of age with musculoskeletal conditions. , 2000, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[46]  S. van der Linden,et al.  Work factors and behavioural coping in relation to withdrawal from the labour force in patients with rheumatoid arthritis , 2001, Annals of the rheumatic diseases.

[47]  R. Feinn,et al.  Factors associated with continued employment among patients with rheumatoid arthritis: a survival model. , 2001, The Journal of rheumatology.

[48]  E. Kulinskaya,et al.  Which patients stop working because of rheumatoid arthritis? Results of five years' follow up in 732 patients from the Early RA Study (ERAS) , 2002, Annals of the rheumatic diseases.

[49]  G. L. Mäkisara,et al.  Prognosis of functional capacity and work capacity in rheumatoid arthritis , 1982, Clinical Rheumatology.