Decline in work disability caused by early rheumatoid arthritis: results from a nationwide Finnish register, 2000–8
- Vappu Marianna Rantalaiho1,
- Hannu Kautiainen2,
- Salme Järvenpää3,
- Lauri Virta4,
- Timo Pohjolainen5,
- Markku Korpela1,
- Timo Möttönen6,
- Kari Puolakka7
- 1Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland
- 2Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
- 3Medcare Foundation, Äänekoski, Finland
- 4Social Insurance Institution, Turku, Finland
- 5Rehabilitation Unit, Orton Hospital, Helsinki, Finland
- 6Department of Rheumatology, Turku University Central Hospital, Turku, Finland
- 7Department of Medicine, Lappeenranta Central Hospital, Lappeenranta, Finland
- Correspondence toVappu Marianna Rantalaiho, Tampere University Hospital, PO BOX 2000, FI-33521 Tampere, Finland;
Contributors All authors contributed to the conception and design of the study and participated in the analysis and interpretation of the data. VMR, HK and KP drafted the article and the other authors revised it critically for intellectual content. All authors approved the final version of this article.
- Received 31 August 2011
- Accepted 19 April 2012
- Published Online First 7 June 2012
Objectives To study whether the work disability (WD) rates in early rheumatoid arthritis (RA) have changed in Finland, where the treatment of RA has long been active but has intensified further since 2000.
Methods All incident non-retired patients with RA of working age (18–64 years) in a nationwide register maintained by the Finnish Social Insurance Institution from 1 January 2000 to 31 December 2007 were identified. Patient cohorts were analysed in 2-year time periods (2000–1, 2002–3, 2004–5, 2006–7) and initial disease-modifying antirheumatic drugs (DMARDs) were elucidated from the drug purchase register. The incidence of continuous WD in the RA cohorts as well as in the entire Finnish population up to 31 December 2008 was analysed.
Results A total of 7831 patients were identified (71% women, 61% rheumatoid factor-positive). Throughout the follow-up period the use of methotrexate and combination DMARDs as the initial treatment of early RA increased. During the first 2 years the incidence of RA-related continuous WD was 8.9%, 9.4%, 7.2% and 4.8% in the year cohorts, respectively (p<0.001 for linearity). Compared with the entire Finnish population, the age- and sex-stratified standardised incidence ratio of a WD pension due to any cause was 3.69, 3.34, 2.77 and 2.80 in the year cohorts, respectively (p<0.001 for linearity).
Conclusions Since 2000 the frequency of continuous WD in early RA has declined in Finland. The present data allow no explanatory analysis but, at the same time, increasingly active treatment strategies have been introduced.
Ethics approval There was no legal requirement for approval by an ethics committee since only unidentifiable register data were used and the patients were not contacted.
Funding This study was financially supported by the Competitive Research Funding of the Tampere University Hospital (Grant 9M124).
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.