Background Rheumatoid arthritis (RA) is a known cause of work productivity loss. Participation in work-related activities is defined as part of the primary goal of RA treatment in the 2015 treat to target recommendations (1).
Objectives The objectives of the current study were to assess changes between baseline and 24 months in work participation in early RA treated according to a tight control treat to target strategy, and to compare sick leave rates to a cohort of early RA patients followed without treat to target.
Methods We used data from two studies: the ARCTIC study (inclusion Oct 2010 – April 2013, RA patients fulfilling the 2010 ACR/EULAR classification criteria, symptom duration<2 years, DMARD-naïve with indication for DMARD) and the NOR-VEAC study (inclusion Oct 2004 – Aug 2010, patients included in the analyses fulfilled 2010 criteria for RA, had symptom duration <16 weeks and were DMARD-naïve). Data collection included patient reported outcomes with identical questions on work participation in both studies, clinical examination and laboratory assessment. In addition, the Work Productivity and Activity Impairment Questionnaire (WPAI) was recorded in ARCTIC. Absenteeism (work time missed) and presenteeism (impairment while at work) were calculated in ARCTIC at baseline and study completion, 24 months. We compared the proportion of patients reporting sick leave (among patients not reporting retirement or disability pension) across studies at baseline, 8 and 16 months, the time points with most data available in both cohorts, by chi-square test.
Results The mean (SD) age for the 229 patients in ARCTIC was 51.4 (13.7) years, disease duration 7.1 (5.4) months, DAS28 4.4 (1.2), 61.1% were female and 86.2% seropositive. The 259 NOR-VEAC patients had shorter mean (SD) disease duration (2.0 (1.0) months, p-value <0.001), higher DAS28 (5.3 (1.3), p-value<0.001) and lower seropositivity rate (74.0, p-value <0.001). NOR-VEAC patients had comparable age (52.7 (14.1) years) and gender distribution (63.9% females) to ARCTIC. In ARCTIC, levels of presenteeism and absenteeism at 2 years were overall very low, with substantial improvement from baseline (figure). While 30.9% of employed patients reported 100% absenteeism at baseline, the corresponding number at 24 months was 3.7%. When comparing the cohorts after 16 months 14.5% of patients in ARCTIC and 26.1% of patients in NOR-VEAC reported sick leave (p-value 0.01). No difference in sick-leave was found between ARCTIC and NOR-VEAC at baseline (34% vs. 40%, p-value 0.24) but a trend was observed at 8 months (19.0 vs. 28.4%, p-value 0.06).
Conclusions Patients with early RA participating in a tight control treat-to-target study reported very little work productivity loss after two years. After treatment, sick-leave rates with treat to target were significantly lower than in a previous cohort of early RA patients followed without implementation of such principles. The results support that patient care based on modern treatment strategies improves participation in work-related activities, a defined goal for RA treatment.
Smolen et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. ARD 2015
Disclosure of Interest None declared