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Which patients stop working because of rheumatoid arthritis? Results of five years' follow up in 732 patients from the Early RA Study (ERAS)

A Young¹, J Dixey², E Kulinskaya³, N Cox⁴, P Davies⁵, J Devlin⁶, P Emery⁷, A Gough⁶, D James⁸, P Prouse⁹, P Williams¹⁰, J Winfield¹¹

¹ City Hospital, St Albans AL3 5PN, UK
² Orthopaedic Hospital, Oswestry TF6 6TF, UK
³ Health Research and Development Support Unit, University of Hertfordshire, UK
⁴ Royal Hants Hospital, Winchester SO22 5DG, UK
⁵ Broomfield Hospital, Chelmsford CM1 6ET, UK
⁶ Selly Oak Hospital, Birmingham B29 6JD, UK
⁷ Rheumatology Research Unit, Leeds LS2 9NZ, UK
⁸ Diana Princess of Wales Hospital, Grimsby DN33 2BA, UK
⁹ District Hospital, Basingstoke RG24 9NA, UK
¹⁰ Medway Hospital, Gillingham ME7 5NY, UK
¹¹ Royal Hallamshire Hospital, Sheffield S11 9EL, UK

Correspondence to:
Correspondence to:
Dr A Young, ERAS Coordinator, Rheumatology Unit, City Hospital, St Albans, Herts AL3 5PN, UK;
erascm{at}hotmail.com

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 England.

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 assessments, and all treatments were recorded prospectively using a standardised 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 Questionnaire (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.

Keywords: rheumatoid arthritis; work; early rheumatoid arthritis; functional outcome; Health Assessment Questionnaire

Abbreviations: CI, confidence interval; DMARD, disease modifying antirheumatic drug; ERAS, Early Rheumatoid Arthritis Study Group; ESR, erythrocyte sedimentation rate; HAQ, Health Assessment Questionnaire; OR, odds ratio; PWD, permanent work disability; RA, rheumatoid arthritis

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