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Psychological and social factors precede work disability in RA

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A systematic review may have unearthed clues to interventions that might prevent work disability in rheumatoid arthritis (RA), a common problem for those with the disease.

It found strong evidence for limitations on activity—high HAQ disability—and physically demanding work predicting work disability on the basis of best evidence synthesis, confirming previous results. Surprisingly, evidence for biomedical variables predicting work disability was inconsistent. The researchers suggest that work disability arises from a biopsychosocial mismatch between work and the worker and that directed interventions might reduce it. However, much greater understanding is needed of employability, lifestyle, physical work tasks, and coping styles and of predictors of work disability in early versus late disease. Given that HAQ disability embodies structural damage, disease activity, pain, and psychological factors, interventions will need to include treatment of the disease and associated problems too.

The review included only studies in which predictive factors preceded work disability and excluded studies examining drug treatment, though the researchers concede that medical treatment in early RA may prevent work disability. They point out that predictors were determined as having a statistical, not an aetiological, link and may be conservative.

Thirteen studies were reviewed. Only 19 papers met the initial criteria out of 391 citations obtained from a search of Cinahl, Embase, and Medline databases (1988/9–2004).

Work disability in RA is generally supposed to result from reduced function versus job demands, but most research has focused on predictive factors in the context of rehabilitation, not prevention.

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