Work Instability Score Predictive of Adverse Work Outcomes in Patients With Axial Spondyloarthritis

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Researchers evaluated the predictive value of the Ankylosing Spondylitis Work Instability Scale on work impact in axial spondyloarthritis.

A moderate to high Ankylosing Spondylitis Work Instability Scale (AS-WIS) score can be predictive of adverse work outcomes in patients with axial spondyloarthritis (axSpA), according to study results published in the Journal of Rheumatology.

The AS-WIS is a 20-item simple screening questionnaire designed to assess the risk for work instability among patients with axial spondyloarthritis. To assess the predictive value of AS-WIS on work outcomes, the current prospective cohort study enrolled patients with axSpA from 3 centers in Paris, France. Patients who received treatment at participating centers between September 2013 and February 2014 were contacted by mail and sent a questionnaire. Patients who responded to the baseline questionnaire were sent a follow-up questionnaire after 1 year. The AS-WIS questionnaire included queries about patients’ demographic and employment data. The primary outcome of the study was the occurrence of any adverse work events, including short-term sick leave (<3 months); long-term sick leave (3 months to 2 years); work disability (state-accepted status of “incapacity to work”); or unemployment. 

The study cohort included 144 patients who were employed at baseline, among whom 101 (70%) responded to the follow-up questionnaire. Patients who did not respond to the second questionnaire had similar demographic characteristics to the responders. Mean age at baseline was 45±9 years; mean disease duration was 14±8 years; and 52% of patients were men. Mean baseline AS-WIS score was 9±5 out of a possible 20. At follow-up, 37 patients (36%) reported an adverse work event, with 25 taking short-term sick leave; 12 long-term sick leave; 5 disability; and 3 unemployment. All patients who reported loss of employment stated that the cause was related to axSpA.  

In multivariable analyses, a higher AS-WIS score was significantly associated with risk for adverse work events. Compared with patients with low AS-WIS scores, patients with moderate to high AS-WIS scores were nearly 3 times as likely to report an adverse work event (odds ratio [OR], 2.71; 95% CI, 1.04-7.22). Lower disease duration was also independently associated with adverse work events (OR, 0.94; 95% CI, 0.89-0.99).

These data support the predictive value of AS-WIS for axSpA-related adverse work events during a median follow-up period of 1.5 years. The AS-WIS may be a means of identifying patients who would benefit from targeted interventions, such as psychologic support, pain management, and adjustments to the workplace to increase accessibility.

“[T]he use of this score in daily practice to identify patients at risk [for adverse work events] should be further explored with the objective to facilitate work retention,” the researchers concluded.


Cucos I, Dadoun S, Jacquemin C, et al. Prediction of work impact in axial spondylarthritis by the Work instability Scale, a prospective cohort study of 101 patients. Published online September 15, 2020. J Rheumatol. doi:10.3899/jrheum.191397.