Sick leave and disability pension before and after initiation of antirheumatic therapies in clinical practice
- 1Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- 2Rheumatology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Correspondence to Martin Neovius, Clinical Epidemiology Unit (T2), Department of Medicine (Solna), Karolinska Institutet, SE-171 76 Stockholm, Sweden;
- Accepted 21 March 2011
- Published Online First 25 April 2011
Objective To investigate sick leave and disability pension in rheumatoid arthritis (RA) in relation to the initiation of biological and non-biological antirheumatic therapies in clinical practice.
Methods Patients aged 19–60 years initiating non-biological mono (n=2796) or combination disease-modifying antirheumatic drug (DMARD) therapy (n=973), or biological agents (n=4787) were identified in the Swedish Rheumatology Quality Register between 1999 and 2007. Sick leave and disability pension data (1995–2010) were retrieved from national registers.
Results During the year before the start of mono DMARD, combination DMARD and biological treatment, 10%, 12% and 43% of patients received disability pension benefits, respectively. The corresponding combined annual sick leave and disability pension days were 78 (54+25), 132 (105+27) and 190 (79+111). Irrespective of treatment type, initiators were characterised by a history of increasing sick leave and disability pension. Treatment start was associated with a break in this trajectory: sick leave decreased while disability pension increased, resulting in a net stabilisation of total days. Higher levels of days on sick leave and disability pension at treatment start were observed in patients initiating biologics in 1999 (236 days/year) compared with 2007 (150 days/year; p<0.001), but the trajectory thereafter remained largely similar and contrasted markedly with the level in the general population.
Conclusion Sick leave and disability pension increased rapidly before the initiation of antirheumatic therapy, which was associated with a halt but not a reversal of this development. Work ability is a metric of importance for clinical practice, signalling large remaining needs in the RA population, and the need for intervention earlier in the disease process.
The ARTIS Study Group E Baecklund (Uppsala University), L Cöster (Linköping University), C Dackhammar (Sahlgrenska Academy), N Feltelius (Medical Products Agency), P Geborek (Lund University), L Jacobsson (Lund University), L Klareskog (Karolinska Institutet), S Lindblad (Karolinska Institutet), S Rantapaa-Dahlqvist (Umeå University), T Saxne (Lund University) and R van Vollenhoven (Karolinska Institutet).
Competing interests The ARTIS Study Group conducts scientific analyses using data from the Swedish Biologics Register ARTIS run by the Swedish Society for Rheumatology. For the maintenance of this register, the Swedish Society for Rheumatology has received funding, independent of the conduct of these scientific analyses, from Schering-Plough, BMS, Wyeth, Abbott Laboratories, UCB and Roche.
Ethics approval This study was conducted with the approval of the regional ethics committee at the Karolinska Institute, Stockholm, Sweden.
Provenance and peer review Not commissioned; externally peer reviewed.
↵* See end of paper for members of the ARTIS Study Group.