Background Rheumatoid arthritis has an important impact on work; more than 10% patients are already in work disability after 3 years of disease. Baseline factors strongly predict this disability. Early and tight control improves disease activity: does this have consequences on later work disability?
Objectives To assess the impact of being in low disease activity (DAS28<3.2) at 6 months and/or 12 months on work disability at five years, after adjusting on baseline predictive factors of work disability.
Methods Early arthritis (EA) patients from the ESPOIR cohort who were under 60 years old, had a paid job at baseline and did not miss any follow-up visits were included in the study. For this analysis, the outcome of interest was work disability at 5 years. Predictive factors of work disability were analysed: (a) based on baseline variables including demographic factors, job characteristics, disease activity and severity factors (DAS28, HAQ, rheumatoid factor/antiCCP positivity, erosions on XRay, fulfilling the ACR/EULAR criteria, CRP), and quality of life (SF-36). (b) The second model included on top of the above variables, the fact of having DAS28<3.2 at least once at the 6 or 12 months follow up visits. (c) The third model included on top of model (a), having a DAS28<3.2 twice (at 6 and 12 months both). Statistics used univariate and multivariate logistic regression.
Results Among the 331 patients included (76.7% female, mean age 45.7 yrs, DAS28 at baseline: 5.1), 56 patients (16.9%) were in disability at 5 years. Low disease activity was achieved at least once for 230 patients (69.5%) and twice for 129 patients (39.0%) during the first year. Low disease activity once or twice during the first year of disease was an independent predictive factor of not being disabled at five years with odds ratios of 0.17 [0.08;0.33] and 0.17 [0.06;0.45] respectively (Table).
Conclusions Achieving LDA at least once during the first year of follow up was an independent predictive factor of less work disability at 5 years in early arthritis with a 5-fold decreased risk of disability, even after adjusting on the baseline variables. This suggests there is a window of opportunity for job retention during the first year by controlling disease activity.
Disclosure of Interest None declared