Predictors of productivity loss in early rheumatoid arthritis: a 5 year follow up study. Monetary value of lost productivity over a five year follow up in early rheumatoid arthritis estimated on the basis of official register data on patients’ sickness absence and gross income: experience from the FIN-RACo trial Short-term influence of adalimumab on work productivity outcomes in patients with rheumatoid arthritis. Work disability in rheumatoid arthritis 10 years after the diagnosis. The work dynamics of the person with rheumatoid arthritis. An intervention program with the aim to improve and maintain work productivity for workers with rheumatoid arthritis: design of a randomized controlled trial and cost-effectiveness study Decreases in health care resource utilization in patients with rheumatoid arthritis following a cognitive behavioral intervention Indirect medical costs in early rheumatoid arthritis: composition of and changes in indirect costs within the first three years of disease. Auranofin treatment in early rheumatoid arthritis may postpone early retirement. Results from a 2-year double blind trial. Work capacity of patients with inflammatory joint diseases. An eight-year follow-up study. Effects of exercise on fatigue, aerobic fitness, and disease activity measures in persons with rheumatoid arthritis. Which patients stop working because of rheumatoid arthritis? Results of five years' follow up in 732 patients from the Early RA Study (ERAS) Ten year outcome in a cohort of patients with early rheumatoid arthritis: health status, disease process, and damage Prediction of progression of radiologic damage in newly diagnosed rheumatoid arthritis. Only high disease activity and positive rheumatoid factor indicate poor prognosis in patients with early rheumatoid arthritis treated with “sawtooth” strategy Effect of adalimumab on the work-related outcomes scores in patients with early rheumatoid arthritis receiving methotrexate. Rheumatoid arthritis and risk of acute myocardial infarction--a nationwide retrospective cohort study.
OBJECTIVE To explore baseline risk factors for productivity loss and work disability over 5 years in patients with early , active RA . PATIENTS AND METHODS In the FIN-RACo trial , 195 patients with recent onset RA were r and omised to receive either a combination of DMARDs with prednisolone or a single DMARD for 2 years . At baseline , 162 patients were working or available for work . After 5 years ' follow up , data on sick leave and retirement were obtained from social insurance registers or case records . The cumulative duration of sick leaves and RA related disability pensions was counted for each patient . To analyse predictors of productivity loss , the patients were divided into four groups according to duration of work disability per patient year . RESULTS Patient 's and physician 's global assessment of RA severity > or = 50 and HAQ score > or = 1.0 were risk factors for extension of productivity loss ( OR ( 95 % ( CI ) 1.77 ( 1.00 to 3.16 ) , 1.85 ( 1.03 to 3.32 ) , and 1.78 ( 1.01 to 3.14 ) , respectively ) . Additional risk factors were low education level ( 2.40 ( 1.18 to 4.88 ) ) and older age ( 1.03 ( 1.00 to 1.06 ) ) ; combination treatment was a protective factor ( 0.59 ( 0.35 to 0.99 ) ) . CONCLUSION At baseline , the risk of future productivity loss is best predicted by education level , age , global assessment s of RA severity , and HAQ score Objective : To explore the monetary value of rheumatoid arthritis related loss of productivity in patients with early active disease . Methods : In a prospect i ve cohort sub study of the FIN-RACo Trial , 162 patients with recent onset rheumatoid arthritis , aged 18 to 65 years and available to the workforce , were followed up for five years . Loss of work productivity in euros 2002 was estimated by data on absence for sickness and on income ( human capital approach ) from official data bases . Treatment responses were evaluated by area under the curve ( AUC ) of the ACR-N measure and by increase in number of erosions in radiographs of h and s and feet . The  health assessment question naire  ( HAQ ) at six months was linked to the International Classification of Functioning , Disability and Health ( ICF ) . Results : In all , 120 ( 75 % ) patients , women more often ( 82 % ) than men ( 61 % ) ( p = 0.002 ) , lost work days . The mean lost productivity per patient-year was € 7217 ( 95 % confidence interval ( CI ) , 5561 to 9148 ) : for women , € 6477 ( 4858 to 8536 ) and for men , € 8443 ( 5389 to 12 898 ) . There was an inverse correlation with improvement : € 1101 ( 323 to 2156 ) and € 14 952 ( 10 662 to 19 852 ) for the highest and lowest quartiles of AUC of ARC-N , respectively . Lost productivity was associated with increase in the number of erosions and with disability in “ changing and maintaining body position ” subcategory of the ICF . Conclusions : Despite remission targeted treatment with disease modifying antirheumatic drugs , early rheumatoid arthritis results in substantial loss of productivity . A good improvement in the disease reduces the loss markedly OBJECTIVE To evaluate the shortterm effect of adalimumab on work productivity in patients with moderate to severe active rheumatoid arthritis ( RA ) . METHODS In a sub study of the Canadian Adalimumab Clinical Trial ( CanAct ) , clinical , health status , and productivity outcomes were measured at baseline and 12 weeks . Patients were classified as responders and nonresponders by the 20 % American College of Rheumatology ( ACR20 ) improvement criterion and the minimum clinical ly important difference ( MCID ) of the Health Assessment Question naire ( HAQ ) score ( 0.22 ) , respectively . The Health and Labour Question naire  ( HLQ ) was used to measure productivity outcomes and costs . RESULTS Included in the analysis were 389 patients completing both baseline and 12-week HLQ question naire . Absenteeism ( a decrease of 0.5 workdays per 2 weeks ) and unpaid work productivity ( 3.5 fewer hours unpaid help per 2 weeks ) were improved significantly after 12 weeks . Improvements in productivity outcomes were associated with clinical response . Bootstrapping results suggest that responders achieved statistically significant improvement in presenteeism ( ACR20 ) and unpaid work productivity ( ACR20 and HAQ ) versus nonresponders . The costs saved by responders were up to $ 155.04 per 2 weeks more than those by nonresponders . CONCLUSION The costs of adalimumab were partially offset , even in the short term , by cost savings induced by clinical response among Canadian patients with moderate to severe RA . These findings complement results of other study analyses that demonstrate early and sustained benefits of adalimumab OBJECTIVE To describe employment status of patients with early rheumatoid arthritis ( RA ) 10 years after diagnosis ; and to identify predictive and associative factors related to permanent work disability . METHODS The study population consisted of 82 patients with early RA who were gainfully employed at onset of RA . Patients were prospect ively followed for an average of 10 years and were treated according to the " sawtooth " strategy . RESULTS After a time since diagnosis of 2 and an average of 9.9 years , respectively , 19/82 ( 19 % ) and 36/82 ( 44 % ) cases have been retired merely or partly due to RA . Further , at the latest checkup 42/82 ( 51 % ) patients were still gainfully employed , while the prevalence of patients working full time under the common retirement age of 65 yrs was 58 % ( 42/72 ) . Cox regression analysis revealed that physically heavy work at baseline was the strongest independent predictive factor for permanent work disability . Ten years after disease onset , however , work disabled patients had more severe disease than those who continued in work . CONCLUSION Our study confirms that the working capacity of patients with RA is in danger from the very start . Despite early and active therapy with disease modifying antirheumatic drugs , at 10 years the cumulative work disability prevalence was 44 % This paper traces the work history of patients with rheumatoid arthritis ( RA ) from the year of diagnosis to 1985 . The paper also describes the risk factors for work loss among patients with RA . It uses data from a panel of 698 RA patients , observed for 4 years , from the practice s of a r and om sample of northern California rheumatologists . Of these 698 , 353 had worked for pay at some point in their lives . Three hundred six of the 353 had worked when diagnosed as having RA . Of these 306 , 157 ( 51 % ) were no longer working in 1985 . Forty-seven individuals started working after the onset of illness , but of these , approximately one-third had stopped working by 1985 . In all , 50 % of RA patients with some work experience stopped working within a decade of diagnosis , 60 % within 15 years , and 90 % within 30 years . We found that the probability of work loss is lessened among persons in jobs that have few physical requirements , among those with high levels of discretion over the pace and activities of work , and among those who were able to stay on the job held when the diagnosis was made . The probability of work loss is increased among service workers . The findings of this longitudinal study , showing that work characteristics profoundly alter the probability of work loss among persons with RA , are consistent with the findings of our earlier cross-sectional studies of work outcome and RA Background Workers with rheumatoid arthritis ( RA ) often experience restrictions in functioning at work and participation in employment . Strategies to maintain work productivity exist , but these interventions do not involve the actual workplace . Therefore the aim of this study is to investigate the (cost)effectiveness of an intervention program at the workplace on work productivity for workers with RA . Methods / design This study is a r and omized controlled trial ( RCT ) in specialized rheumatology treatment centers in or near Amsterdam , the Netherl and s. R and omisation to either the control or the intervention group is performed at patient level . Both groups will receive care as usual by the rheumatologist , and patients in the intervention group will also take part in the intervention program . The intervention program consists of two components ; integrated care , including a participatory workplace intervention . Integrated care involves a clinical occupational physician , who will act as care manager , to coordinate the care . The care manager has an intermediate role between clinical and occupational care . The participatory workplace intervention will be guided by an occupational therapist , and involves problem solving by the patient and the patients ’ supervisor . The aim of the workplace intervention is to achieve consensus between patient and supervisor concerning feasible solutions for the obstacles for functioning at work . Data collection will take place at baseline and after 6 and 12 months by means of a question naire . The primary outcome measure is work productivity , measured by hours lost from work due to presenteeism . Secondary outcome measures include sick leave , quality of life , pain and fatigue . Cost-effectiveness of the intervention program will be evaluated from the societal perspective . Discussion Usual care of primary and outpatient health services is not aim ed at improving work productivity . Therefore it is desirable to develop interventions aim ed at improving functioning at work . If the intervention program will be (cost)effective , substantial improvements in work productivity might be obtained among workers with RA at lower costs . Results are expected in 2015.Trial registration We previously reported the efficacy of a multicomponent cognitive-behavioral intervention including biofeedback to decrease pain , affective distress , and objective measures of disease activity in patients with rheumatoid arthritis ( RA ) . In the present article we report evidence that this intervention is associated with reductions in RA-related clinic visits and days hospitalized as well as reductions in the costs of these medical services . Data were independently and objective ly collected over an 18-month interval as part of a controlled group outcome study . The importance of documenting economic as well as clinical benefits of our treatments in specific patient population s is noted OBJECTIVE To investigate 1 ) the magnitude of indirect costs , 2 ) changes in cost components , and 3 ) correlations between changes in cost and social , clinical , and occupational variables within the first 3 years of rheumatoid arthritis ( RA ) . METHODS We evaluated the indirect costs  per person-year in 133 consecutive gainfully employed out- patients with early RA , in a prospect i ve multicenter followup study . Costs due to RA-related sick leave , work disability , and other work loss were assessed using the human capital approach . Variables associated with reduction in lost productivity were tested by multivariate logistic regression analysis . RESULTS Mean + /- SEM annual indirect costs were $ 11,750 + /- 1,120 per person . During the 3-year period of observation , a marked reduction in the costs associated with sick leave was seen , which exceeded the increase in costs due to work disability and other work loss . This phenomenon result ed in an overall reduction in indirect costs of 21 % . The final logistic regression model of reduced loss of productivity included 3 variables : no problems with st and ing ( odds ratio [ OR ] 7.1 ) , no problems with working speed ( OR 4.1 ) , and no problems with outdoor work ( OR 3.1 ) . CONCLUSION High indirect costs in early RA were demonstrated . An overall decrease of costs can be seen in the first 3 years , due to the reduction in sick leave . Since the absence of problems due to strenuous working conditions was found to be associated with a reduction in indirect costs , it is assumed that early intensified vocational rehabilitation , apart from controlling disease activity by adequate treatment , might help to reduce indirect costs The effect of early vs delayed initiation of slow acting antirheumatic drug ( SAARD ) therapy on the ability to maintain regular work , was evaluated in 83 patients with early rheumatoid arthritis ( RA ) in a placebo controlled , double blind 24-month study . The estimated probability to maintain working ability was higher in the early treatment group , especially during the second study year . Predicting factors were age , type of work , degree of disability and number of swollen joints . Despite the difficulties in interpreting the results due to the complexity of the underlying socioeconomical and labor market situation , the study supports early treatment in RA with regard to the maintenance of normal life In a prospect i ve study of recent arthritis , 103 patients had rheumatoid arthritis ( RA ) , 63 seronegative oligoarthritis ( SO ) , 67 reactive arthritis ( REA ) , 20 ankylosing spondylitis ( AS ) , and 13 psoriatic arthritis ( PA ) . At the 8-year check-up , 36 % of patients with RA were at work , compared with 69 % in PA ( p less than 0.002 ) , and 85 - 90 % in AS , SO , and REA ( p less than 0.001 ) . Correspondingly 43 % of the RA patients were disabled by arthritis , compared with 23 % in PA ( NS ) , 15 % in AS ( p less than 0.005 ) , none in SO , and 4 % in REA ( p less than 0.001 ) . No significant differences in work capacity were noted between patients with PA , AS , SO or REA . In RA , the educational background s of patients unable to work ( 44 patients ) and able to work ( 37 patients ) did not differ from each other or from the overall population of Finl and , but a significantly ( p less than 0.01 ) smaller number of patients with arduous work were able to continue at work . The mean age of 49 years for RA patients unable to work differed highly significantly ( p less than 0.001 ) from the 35 years of RA patients at work . However , the weightiest cause of limited work capacity was severity of disease The effects of 12 weeks of low-impact aerobic exercise on fatigue , aerobic fitness , and disease activity were examined in a quasi-experimental time series study of 25 adults with rheumatoid arthritis ( RA ) . Measures were obtained preintervention , midtreatment ( after 6 weeks of exercise ) , end of treatment ( after 12 weeks of exercise ) , and at a 15-week follow-up . ANOVAS for repeated measures showed that those subjects who participated more frequently reported decreased fatigue , while those who participated less frequently reported an increase in fatigue . All subjects , on average , showed increased aerobic fitness and increased right and left h and grip strength , decreased pain , and decreased walk time . There were no significant increases in joint count or sedimentation rate . Significant improvements in measures at the 15-week follow-up also were found . Findings indicate that persons with RA who participate in appropriate exercises may lessen fatigue levels and experience other positive effects without worsening their arthritis Objectives : To assess the occurrence and prognostic factors for the ability to maintain paid work in patients with rheumatoid arthritis ( RA ) . Setting : Inception cohort of patients with RA recruited from rheumatology departments in nine NHS Hospital Trusts in Engl and . Patients : All consecutive patients with RA of less than two years ' duration , before any second line ( disease modifying ) drug treatment , and followed up for five years . Methods : Clinical , laboratory , and radiological assessment s , and all treatments were recorded prospect ively using a st and ardised format at presentation and yearly . Outcome measures : Changes in , and loss of paid work by five years ' follow up . Results : 732 patients completed the five year follow up . 353/721 ( 49 % ) were gainfully employed at the onset of RA , 211 ( 60 % ) were still working at five years , 104 ( 29 % ) stopped because of the disease , and 31 ( 9 % ) retired for reasons other than RA . Work disability at five years was more likely in manual workers ( odds ratio ( OR ) 2.3 , 95 % confidence interval ( CI ) 1.4 to 3.8 ) and worse baseline Health Assessment Question naire ( HAQ>1.5 , OR 2.26 , 95 % CI 1.38 to 3.7 ) . In combination with other baseline variables ( erythrocyte sedimentation rate , sex , age of onset , and radiological erosions ) , employment outcome was predicted in 78 % using multivariate analysis . Conclusions : Nearly half of the patients with RA were in paid employment at onset , work disability was an adverse outcome for a third of these patients by five years , and manual work and high baseline HAQ were important predictors for this . These details are likely to be useful to clinicians , health professionals , and patients in order to plan medical , orthopaedic , and remedial treatments in early RA . Future disease modifying treatments could be compared with this cohort of patients who were treated with conventional second line drugs Objective : To investigate outcome as measured by health status , disease process , and damage in an unselected group of patients with early rheumatoid arthritis ( RA ) monitored prospect ively for 10 years and to search for prognostic factors . Patients and methods : 183 patients with RA with disease duration < 2 years were assessed annually at a team care unit . Health status was measured by the  Health Assessment Question naire ( HAQ ) and functional class .  Disease process was assessed by clinical and laboratory measures of disease activity and evaluation of disease course . Damage was quantified as occurrence of major extra-articular manifestations and need for large joint replacements . Possible predictive factors were evaluated by logistic regression analyses . Results : 168/183 patients completed the entire follow up period . Of all 183 patients , 137 ( 75 % ) had been treated with disease modifying antirheumatic drugs and 84 ( 46 % ) with low dose oral glucocorticoids . After 10 years 158 patients ( 94 % ) managed daily life activities independently ( functional class I – II ) . As measured by the HAQ 20 % had almost no disability , 28 % were mildly disabled , and 10 % were seriously disabled . Median HAQ score had increased from 0.8 to 1.1 ( p<0.001 ) . Disease activity was significantly reduced . 133 patients ( 79 % ) had a relapsing remitting disease course and 30 patients ( 18 % ) were in remission as defined by the American College of Rheumatology criteria . Thirty patients ( 17 % ) had undergone large joint replacements . Fifteen patients ( 8 % ) had developed major extra-articular complications . The HAQ score during the first three months predicted disability at 10 years with an odds ratio of 13.4 . Conclusions : Prospect i ve studies such as this give important knowledge of the variable long term prognosis of RA and provide necessary background information for clinical trials of new treatment modalities OBJECTIVE To investigate the extent to which early radiologic damage is predicted by joint inflammation in patients with newly diagnosed rheumatoid arthritis ( RA ) . METHODS Regression analysis was performed on 1-year progression of total radiologic damage for baseline characteristics and cumulative disease activity measures , and the effects of continued joint inflammation on the progression of damage in separate joint groups were investigated . RESULTS Odds ratios for progression of total damage were 12 for the presence of rheumatoid factor , 5 for the presence of damage at baseline , and 2 for cumulative joint inflammation . A positive association between continued joint inflammation and progression of damage was found to be statistically significant for most joint groups . CONCLUSION Progression of radiologic damage in patients with newly diagnosed RA is independently associated with the presence of rheumatoid factor and damage at baseline and with cumulative joint inflammation OBJECTIVES To investigate the prognostic significance of clinical and genetic markers on the outcome of patients with recent-onset rheumatoid arthritis ( RA ) treated actively with slow acting antirheumatic drugs ( SAARDs ) .  METHODS A total of 142 consecutive patients with early RA ( median disease duration of 7 months ) were treated according to the “ sawtooth ” strategy and prospect ively followed up for an average of 6.2 years . Several clinical parameters at start as well as genetic markers were related to the functional outcome ( ARA Functional class and HAQ disability score ) and radiographic joint damage ( Larsen ’s score ) at the latest visit . RESULTS In logistic regression analysis only Mallya score ( including morning stiffness , pain scale , grip strength , Ritchie ’s articular index , haemoglobin , and erythrocyte sedimentation rate ) at baseline , and Mallya score and rheumatoid factor ( RF ) positivity at one year were found to be of significance with respect to the radiographic outcome of the patients . Furthermore , at the latest visit HAQ score was related to radiographic score . At baseline the mean ages of the DR4 positive patients and the patients with RA associated DR alleles were statistically significantly lower than those without the above mentioned risk factors ( 44 v 49 , p=0.03 and 41 v 53 , p=0.04 , respectively ) . However , these genetic markers had no prognostic significance on the functional or radiographic outcome of the patients . CONCLUSION High clinical disease activity at baseline and RF positivity especially at one year after the institution of SAARD treatment are the best predictors of poor prognosis in early RA . However , from the clinical point of view , the disease outcome of an individual patient with early RA , can not be predicted accurately enough by present means OBJECTIVES To evaluate the effects of adalimumab plus MTX ( ADA + MTX ) vs MTX monotherapy on work-related outcomes in early RA patients with elevated risk of employment loss . METHODS A post hoc analysis at weeks 26 and 24 from the Optimal Protocol for Treatment Initiation with Methotrexate and Adalimumab ( OPTIMA ) and PRevention Of Work Disability ( PROWD ) trials , respectively , was conducted in  MTX-naïve RA patients r and omized to ADA + MTX or placebo ( PBO ) + MTX .  Work instability was assessed using the RA-Work Instability Scale ( RA-WIS ) and work productivity was measured with the Work Productivity and Activity Impairment Question naire . Employed patients with a baseline RA-WIS score ⩾10 , indicating medium to high risk for job loss , were included ( OPTIMA , n = 320 ; PROWD , n = 124 ) . RESULTS Patients receiving ADA + MTX in OPTIMA had significantly greater improvements in RA-WIS compared with PBO + MTX ( mean change -7.22 vs -5.23 , respectively ) . Significantly higher percentages of patients in the ADA + MTX group experienced improvements in one or more risk category ( 58 vs 47 % ) and ⩾5 ( 55 vs 43 % ) , ⩾7 ( 47 vs 35 % ) and ⩾9 ( 42 % vs 26 % ) points in their RA-WIS score . These trends were seen in PROWD but were not significant . In OPTIMA , patients receiving ADA + MTX showed significant changes in percentage points from baseline vs PBO + MTX  in activity impairment , presenteeism and overall work impairment ( -32.0 vs -23.7 , -24.6 vs -17.1 , -27.3 vs -18.3 , respectively ) . CONCLUSIONS Among early RA patients with elevated risk of employment loss , ADA + MTX therapy was associated with a significant reduction in work  instability vs PBO + MTX . Significantly greater percentages of patients receiving ADA + MTX therapy achieved clinical ly meaningful improvements in their RA-WIS scores OBJECTIVES Rheumatoid arthritis ( RA ) imposes substantial social costs , including an increased risk of work-related disability and accelerated cardiovascular diseases . The aim of the study is to determine the risk of acute myocardial infa rct ion ( AMI ) associated with RA in a nationwide retrospective cohort study . METHODS Using the catastrophic illness registry of the Taiwan National Health Insurance Research Data base ( NHIRD ) , we identified patients with RA from 1998 to 2010 . We also r and omly selected non-RA controls frequency-matched by age , sex , and index year from the general population free of RA . The risk of AMI was analyzed using Cox proportional hazards regression models including sex , age , and comorbidities . RESULTS From a total of 23.74 million people in the cohort , 29,260 RA patients and 117,040 controls were followed for 193,987 and 792,254 person-years , respectively . The incidence density rate increased in all groups of RA patients than those of the controls . RA patients had a 1.33-fold higher overall incidence of AMI than controls , with an adjusted hazard ration of 1.38 . Although the overall adjusted hazard ratio of AMI increased with age , the age-specific RA patients to controls incidence rate ratio was higher for younger RA patients . Subjects with comorbidities of hypertension , diabetes hyperlipidemia , CVA , COPD , or ESRD had increased risk of AMI .  Subjects with ESRD had the highest hazard of AMI . CONCLUSION This nationwide retrospective cohort study indicates that AMI risk increased by 38 % in RA patients compared to the general population . Comorbidities increase the AMI risk independently
RA-related work-disability rates were similar in the USA and European countries .
An apparent decrease in the prevalence of RA-related work disability since the 1970s may be related to a decrease in physically dem and ing work rather than to epidemiologic changes in RA .
The majority of the literature addresses permanent disability and temporary work loss ; none of the studies review ed reported the effect of RA on presenteeism , i.e. work limitation from the employer perspective , and there are few published studies of the effectiveness of disease-modifying anti-rheumatic drugs in reducing work-related productivity loss
BACKGROUND Rheumatoid arthritis ( RA ) is a chronic , debilitating disease with a significant impact on workplace productivity .
AIM To perform a systematic review of studies of the relationship between RA and reduced  workplace productivity .