Background Despite advances in medical therapies, the chronicity of symptoms of Juvenile Idiopathic Arthritis (JIA) in childhood and the potential for attendant disability persisting into adulthood may adversely influence educational attainment and the ability to secure and maintain gainful employment in a way which has not been well-defined.
Objectives Postulating that there are likely to be a series of indirect and direct effects of the disease, we investigated the impact of patient and disease specific factors on education and employment outcomes in an adult JIA population.
Methods A prospective, observational cohort study of 103 consecutive adult patients attending a JIA continuity clinic was performed. These included questions on educational achievement and employment status; a Health Assessment Questionnaire (HAQ score); and, for those who were in employment, a Work Instability Score (RA-WIS). A combination of generalised linear modelling and structural equation modelling was used to explore the complex interactions between JIA subtype, age, disease duration, functional disability, educational achievement and employment outcomes.
Results The median age of the patients was 24 years (range 17-71) with median disease duration of 19 years (range 7-67). Of the 103 patients, 64% (n=66) were in either full- or part-time employment. Functional disability (HAQ score) was significantly lower in patients who were in employment (mean=0.83, s.d.=0.85,) compared to those not in any (mean=1.25, s.d.=0.92) (p=0.03), and those with oligoarticular JIA (t=2.29, p=0.02) versus other JIA subtypes. Educational achievement was not influenced by JIA subtype (F=1.18, p=0.33). Educational achievement in General Certificate of Secondary Education (GCSE) examinations (F=11.63 p=0.001) had a positive impact on the type of job achieved in later life, with higher success leading to more professional or managerial posts. Job stability was influenced positively by educational achievement at GCSE and negatively by the disability score (t=10.94 p=6.36-16), which were themselves impacted by age of patient.
Conclusions We have used modelling techniques to study the key patient and disease variables for employment in adult patients with JIA. We have measured the impact of the disease on employment outcomes like duration of employment, job classification status achieved and problems encountered at work. Our study suggests that the interactions between disability, education and employment are subtle: influencing both job type and the stability of employment. This has implications on the choice of occupation and forms the basis for further research to guide career decisions for these patients.
Disclosure of Interest None Declared