EULAR Releases Points-to-Consider to Improve Work Participation Among Patients With Rheumatic Diseases

The European Alliance of Associations for Rheumatology (EULAR) developed points-to-consider to improve and support work participation among patients with rheumatic and musculoskeletal diseases (RMDs). The guidance was published in Annals of the Rheumatic Diseases.

Patients with RMDs have lower rates of participation in paid work compared with the general population. It is also well known that RMDs are a leading cause of work disability.

A EULAR taskforce was convened to improve and support paid work participation among patients with RMDs.

A steering group identified the research strategy and collected and synthesized supporting data. Six areas of research were identified to inform recommendation development. Three systematic literature reviews, 2 surveys, and 2 nonsystematic literature reviews were included. The taskforce convened in May 2021 to review the evidence and establish points-to-consider through a process of discussion and voting. Consensus was defined as greater than 75% agreement. Level of evidence and strength of recommendation were added to each statement after the meeting. An anonymous online survey of the taskforce was used to obtain level of agreement, which ranged from 0 (do not agree at all) to 10 (agree fully).

Overarching Principles

• Participation in good work (ie, engaging, fair, secure, and accommodating) promotes self-worth, self-esteem, economic stability, and social inclusion, which translate to better health and wellbeing.
• Work-related support for patients with RMDs should aim to safeguard their physical and mental health while helping them remain employed, return to work, or not participate in paid work if that is their informed choice.
• Supporting patients with RMDs to participate in healthy and sustainable work is a shared responsibility of members of society and requires collaboration and consideration of their lived experience.

Points-to-Consider

• Support should reflect the stage of RMD while encouraging people to enter, sustain, and/or return to work.
• Timely access to support, including early identification and personalized assistance, can help promote sustained work and prevent long-term absence.
• Collaboration among stakeholders, including health professional organizations, policy makers, patient organizations, and employers, is essential to increase employment opportunities for patients with RMDs.
• Patients with RMDs may need support to make decisions about sharing disease-related information with their employer and to express their needs to relevant stakeholders.
• Working while sick and absences due to sickness predict long-term sick leave and future work disability, and these factors should be an indicator to consider support processes.
• Biopsychosocial factors encompass a wide range of contextual influences that affect work outcomes and must be considered when assessing the work needs of patients with RMDs.
• Treatment with disease-modifying drugs improves work participation, especially for patients with early rheumatoid arthritis (RA) and axial spondyloarthritis, and it should be initiated as early as possible.
• Nonpharmaceutical interventions, such as education, exercise, and workplace adaptations, should be considered to improve work outcomes.
• Social security systems should develop and implement work sustainability and return-to-work policies that respect the rights of patients with RMDs.
• Supportive attitudes of employers, supervisors, and colleagues are essential for healthy and sustainable work among patients with RMDs.
• Employers, in cooperation with other stakeholders such as unions, disability managers, and occupational physicians, should adopt policies that encourage a workplace culture of inclusivity, flexibility, and support.

Several knowledge gaps were identified during the collection of evidence and development of recommendations. The taskforce recommended a range of research topics to better understand the following:

• The role of health care providers, employers, and other stakeholders
• Improvement of collaboration between stakeholders
• Defining, assessing, and monitoring healthy and sustainable work
• The policies that support sustainable work for patients with RMDs and the related cost effectiveness
• Implementation of evidence-based interventions

The taskforce concluded, “Considering and implementing these EULAR [points-to-consider] are a shared responsibility and should improve healthy and sustainable work participation of people with RMDs.”