Background Indirect costs of rheumatoid arthritis (RA) due to losses such as reduced productivity are an important social issue in addition to rapidly increasing direct costs; however, work disability in patients with RA have not been thoroughly assessed in Japan. With the recent changes in socioeconomic structure, the number of female paid workers has been increasing; thus, the impact of RA on the work impairment of Japanese patients has been rapidly increasing. In addition, work status is strongly influenced by cultural differences among races. Furthermore, with the recent improvement of RA treatment strategy, it has not been evaluated whether work disability in patients with RA improved or not in a real world settings. Hence, we evaluated longitudinally work impairment in patients with RA in daily practice using a large cohort database.
Objectives To study how the magnitude of work impairment in Japanese patients with rheumatoid arthritis (RA) has changed over the past 3 years in routine clinical practice.
Methods Patients with RA who participated in both of the IORRA studies conducted in April 2012 and April 2013 and those who worked for pay on both surveys and were aged 55 years or younger at baseline were identified. Changes over the 3 years in the absenteeism (AB), presenteeism (PR) and overall work impairment (OWI) scores as determined by the Work Productivity and Activity Impairment (WPAI) were evaluated in those patients. In addition, patients with work impairment, defined as AB >0% or PR ≥30%, at baseline were classified according to whether or not they still had work impairment at 3 years to identify differences in their characteristics.
Results Among 4,214 patients with RA who participated in both of the IORRA studies, 1,310 patients were selected in this study cohort (mean age, 51.5 years; females, 80.1%; Japanese version of the HAQ [J-HAQ], 0.37). The AB, PR, OWI scores in the 1310 patients were 1.8%, 16.4% and 17.3%, respectively, at baseline, which remained unchanged at 3 years (2.1%, 16.4% and 17.6%, respectively). At baseline, 206 patients (15.7%) had work impairment, of whom 117 patients (56.8%) (mean age, 43.8 years; females, 85.5%; DAS28, 3.1 [2.8 at 3 years]; J-HAQ, 0.80 [0.75 at 3 years]; 73.5% [76.9% at 3 years] of patients received methotrexate; 36.8% [38.5% at 3 years] received biologics) continued to have it at 3 years, and 89 patients (43.2%) (mean age, 44.2 years; females, 84.3%; DAS28, 3.2 [2.1 at 3 years]; J-HAQ, 0.54 [0.25 at 3 years]; 77.5% [82.0% at 3 years] of patients received methotrexate; 24.7% [39.3% at 3 years] received biologics) were free from work impairment.
Conclusions In the overall population of Japanese patients with RA, work impairment has not been improved over the past 3 years; however, as many as 43.2% of patients with work impairment at baseline have experienced improved work productivity. In these patients, more intensive RA therapy has resulted in a greater reduction in disease activity or functional impairment.
Disclosure of Interest E. Tanaka Speakers bureau: ET has received speaker fees or consulting fees from Abbvie, Eisai Pharmaceutical, Chugai Pharmaceutical, Bristol Myers Squibb, Astellas Pharmaceutical, Pfizer, Takeda Pharmaceutical, and Santen Pharmaceutical., E. Inoue: None declared, R. Yamaguchi: None declared, Y. Shimizu: None declared, N. Sugimoto: None declared, D. Hoshi: None declared, K. Shidara: None declared, E. Sato: None declared, Y. Seto: None declared, A. Nakajima: None declared, S. Momohara Speakers bureau: SM has received speaker fees from Abbott, AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Eisai, Mitsubishi Tanabe, Pfizer, Takeda, and Teijin., A. Taniguchi: None declared, H. Yamanaka Speakers bureau: HY has received speaker fees from Abbott, AbbVie, Asahikasei, Astellas, AstraZeneca, Bristol-Myers Squibb, Chugai, Daiichi Sankyo, Eisai, GlaxoSmithKline, Janssen, Mitsubishi Tanabe, MSD, Nippon Kayaku, Pfizer, Santen, Taishotoyama, Takeda, and Teijin.