Working to reduce work disability in rheumatoid arthritis

A study of patients with rheumatoid arthritis (RA) may point the way towards better treatment, thereby allowing them to stay in work longer. By identifying predictors of loss of paid work early in the course of the disease the study paves the way for management programmes better suited to facilitating coping at work—with alternatives to using drugs to control the condition—before work disability sets in.

Forty per cent of the 353 recruits working at entry to the study were not working five years later, over half (56%) because of RA. Work disability was more likely with manual work (odds ratio 2.97, 95% confidence interval 1.26 to 6.9), joint erosions (2.09, 1.19 to 3.64), high erythrocyte sedimentation rate (ESR) (2.37, 1.4 to 3.9), and worse baseline scores for the disability index of the Health Assessment Questionnaire (HAQ ≥1.5; 2.26, 1.38 to 3.7). With HAQ score, ESR, age of onset of RA, joint erosions, and sex, work outcome was predicted in 78% in multivariate analysis.

The findings are from a five year follow up of 723 patients in the early RA study (ERAS). The patients were consecutive attendees at rheumatology clinics in nine districts in England whose onset of RA was no more than two years previously and who had not started second line treatment. They were assessed yearly for a range of clinical variables—pain/swelling, erosions, disability index, ESR, rheumatoid factor—other illnesses; socioeconomic indicators; and type of employment, including change in working hours, sick leave, and permanent work disability.