Workplace, Clinical Factors Linked to Employment Outcomes in Axial Spondyloarthritis

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Data identified both clinical and employment factors that may predict poor work outcomes in patients with axial spondyloarthritis.

Study data published in The Journal of Rheumatology identified both clinical and employment factors that may predict poor work outcomes in patients with axial spondyloarthritis (axSpA). Specifically, high disease activity, a labor-intensive job, and poorer physical function were all independently associated with work absence. 

The British Society for Rheumatology Biologics Register in Ankylosing Spondylitis (BSRBR-AS) is an ongoing prospective cohort study of patients ≥16 years with axSpA from 83 centers across Great Britain. Participants are naïve to biologic therapy and meet the Assessment of Spondyloarthritis International Society criteria for axSpA. Per BSBR-AS protocol, patients were assessed using the Work Productivity and Activity Impairment Specific Health Problem scale. Patient-reported measures of health, quality of life, and sociodemographic factors were also collected in addition to medical history. For the present analysis, investigators dispensed questionnaires regarding work status to BSRBR-AS participants at baseline in December 2012. Subsequent follow-up data was abstracted from the June 2017 BSRBR-AS database.

The study cohort comprised 1188 participants who reported paid employment at baseline, of whom 65% were men, 55% worked at a sedentary job, and 83% were HLA-B27-positive. Median participant age was 44 years and the median age at referral to a rheumatologist was 33. After adjusting for age, sex, and deprivation, the likelihood of working decreased with higher disease activity, poorer physical function, poorer spinal mobility, and reported worse quality of life. Of working participants, 79% reported some degree of presenteeism regarding their axSpA during the past week and 19% reported some absenteeism. A total of 52 participants reported leaving work during the follow-up period while still of working age. Subsequent analyses included all available follow-up time points and adjusted for age, sex, and deprivation.

According to the fully-adjusted generalized estimating equation analysis, absenteeism was the only significant predictor of leaving work 12 months later (relative risk [RR], 1.02; 95% CI, 1.01-1.03). Regarding absenteeism within 12 months, however, the linear regression model highlighted presenteeism (RR, 0.1; 95% CI, 0.04-0.2), a labor-intensive job (RR, 2.3; 95% CI, −0.4 to 5.0), and peripheral joint involvement (RR, 4.3; 95% CI, −0.4 to 5.0) as associated factors. Independent factors independently associated with future presenteeism included high disease activity (RR, 0.76; 95% CI, −0.2 to 1.8), fatigue (RR, 2.3; 95% CI, 1.8-2.8), a labor-intensive job (RR, 3.4; 95% CI, 0.6-6.1), and poorer physical function (RR, 0.9; 95% CI, −0.03 to 1.8).

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These data highlight potential areas of intervention for clinicians looking to improve work outcomes in patients with axSpA. Specifically, patients with presenteeism and a labor-intensive job are more likely to report absenteeism, which subsequently increases the risk for leaving work altogether. Future research regarding biologic therapy and disease activity may be important to improving workplace productivity in patients with axSpA.

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Macfarlane GJ, Shim J, Jones GT, Walker-Bone K, Pathan E, Dean LE. Identifying persons with axial spondyloarthritis at risk of poor work outcome: results from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis [published online November 1, 2018]. J Rheumatol. doi:10.3899/jrheum.180477