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Pacing predicts leaving work in ankylosing spondylitis

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Patients with ankylosing spondylitis (AS) should benefit from better informed programmes to keep them working, thanks to a cross sectional study of risk factors for giving up work.

The survey showed that giving up work was not related to length of disease. Among 577 patients who had worked after the diagnosis, 156 (27%) stopped mostly for medical reasons, citing physical limitations (86%) and tiredness (77%). Greater disease activity, disability, different coping strategies (for pain, limitations, and dependency), and decreased overall wellbeing were among the contributory disease factors. Employment factors were industrial occupation; non-professional occupation; no specific job training; and physically demanding job; plus problems with access, mobility, more dependency on colleagues, and negative attitudes at work.

Multivariate analysis showed that pacing to cope with limitations was the most significant risk factor (73%), followed by seeking creative solutions to coping (36%), greater disease activity, greater age, and insufficient support at work. Conversely, technical or ergonomic changes could have saved 73% of withdrawals. Working in a company of over 100 employees and accepting dependency as a coping strategy meant less withdrawal from working.

The findings came from a self reported survey of 658 patients with AS, covering work, disease, function, quality of life, and coping strategies.

Widely varying employment rates are reported for patients with AS for 12 years or more, but no previous study has looked for an independent effect of length of disease and remaining in work. Other studies have included a smaller range of variables and only two have used multivariate analysis.