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Abstract
Background Rheumatoid arthritis (RA) is known to have adverse consequences on those undertaking paid employment. Little is known about the association between psychological factors and these work related outcomes.
Objectives To establish whether demographic, clinical and psychological characteristics predict sick leave in the first 6 months following start of methotrexate (MTX) in patients with RA.
Methods The Rheumatoid Arthritis Medication Study (RAMS) is a national, UK multi-centre observational study studying response to MTX in RA. Demographic and clinical data (including HAQ and DAS28) are collected at baseline (start of treatment) and 6 months after starting MTX along with measurements of pain and fatigue (VAS), Hospital Anxiety and Depression scale (HADS), the Illness Perception Questionnaire (IPQ), working status and job type. At 6 months, patients in paid employment were asked to provide sick leave data due to arthritis for the previous 6 months. This analysis included patients who had completed a minimum of 6 months of follow-up by December 2012. Univariate logistic regression analysis was applied to assess the association between baseline characteristics and whether patients took subsequent sick leave or not.
Results Data on working status at baseline and 6 months was available for 294 RA patients (66% female; mean age 59 (SD 12.9) years). Median symptom duration at start of MTX was 9 months [IQR 5-33]. At baseline, 45% patients were in paid employment (43.5% retired, 5.1% work disabled or retired early due to RA, 3.1% working full time from home, 1.3% unemployed and 2% ‘other’). At 6 months, data on sick leave were available for 128 (97%) patients in paid-employment, with 26% reporting at least one period of sick leave and 18% requiring a change to their working environment. The median number of sick days at 6 months was 10 [IQR 1-186]. Higher baseline measures of disability, pain, fatigue, psychological distress and most dimensions of the IPQ were found to be significant predictors of sick leave during the first 6 months after starting MTX (Table). EULAR non-responders were more likely to report sick leave compared to EULAR good responders (OR 3.0, 95%CI 1.10 to 8.34).
Conclusions Over one-quarter of patients reported a period of time off work for their RA following commencement of MTX, with the findings of this study suggesting that psychological factors play an important role in predicting future sick leave.
Disclosure of Interest None Declared