Background Working age patients with rheumatoid arthritis (RA) often struggle to maintain their physical functioning and ability to work outside the home due to the impact of chronic joint inflammation and subsequent joint damage.
Objectives Our objective was to evaluate the demographic and clinical factors associated with maintaining employment over time among RA patients who are participants of a multi-centered observational registry within the United States (the Consortium of Rheumatology Researchers of North America: CORRONA).
Methods We identified RA patients enrolled within CORRONA (3/1/06-12/5/11) who were aged 18 to 64 years, working full-time at the time of enrollment and followed over time. Survival analysis was performed assessing the time from enrollment to the first visits where the patient reported discontinuing working (full-time or part-time). Cox proportional hazards models were used to examine the factors associated with persistency of working adjusting for clustering of physician. Covariates of interest included age, gender, geographic region, education, living arrangement, comorbid conditions, functional status as measured by the modified Health Assessment Questionnaire (mHAQ), and receipt of joint surgery. Disease activity (measured based on the Clinical Disease Activity Index [CDAI] and medication use including biologics (± nonbiologic disease modifying anti-rheumatic drug [DMARD]), nonbiologic DMARDs and prednisone were examined as time-varying covariates.
Results There were 5,470 patients with a mean age of 49.5 (±9.4), mean disease duration of 7.0 years (± 7.8). Most were women (74.3%) living with a partner or spouse (71.8%) with a college education (68.3%). At enrollment, almost all were receiving either a nonbiologic DMARD (51.3%) or biologic (42.6%) while a quarter were on prednisone. There were 792 patients who discontinued working overall with a cumulative rate of 28.0%, 35.1% and 41.5% at 4, 5 and 6 years respectively using survival analysis. As shown in Table 1, increasing age, functional impairment (based on the mHAQ), increasing disease activity and use of prednisone were associated with discontinuing working in unadjusted and adjusted analyses while biologic agents appeared protective.
Conclusions In this working age group of RA patients, increases in disease activity and functional impairment were associated with discontinuing work. This suggests that rheumatologists need to consider aggressive treatment of ongoing disease activity including use of biologics to prevent work loss.
Disclosure of Interest L. Harrold Consultant for: CORRONA, M. Cifaldi Shareholder of: Abbott, Employee of: Abbott, K. Saunders Employee of: CORRONA, G. Reed Grant/Research support from: CORRONA, Consultant for: CORRONA, Employee of: University of Massachusetts Medical School, Paid Instructor for: Harvard Medical School, A. Ganguli Shareholder of: Abbott, Employee of: Abbott, Y. Shan: None Declared, J. Greenberg Shareholder of: CORRONA, Consultant for: AstraZeneca, Novartis, Pfizer, CORRONA