Background Long term sickness absence (LTSA), unemployment and early retirement are some of the most important outcomes of rheumatoid arthritis (RA), both for patient and society. Historically, RA patients have increased risk of LTSA and early disability pension. Modern treatment strategies have improved disease control in the last decades, and a decreased risk of LTSA and disability pension during later years have been reported. It is not known whether this represents a disease-specific decline or if the reduction of disability pension merely reflects a reduction in disability pension in general, due to political, demographic, and socioeconomic changes.
Objectives To study in a multi-state model 1) the risks of LTSA, unemployment, and disability pension, and the chance of return to work in RA compared to a matched control population and 2) the changes in risks between1994–2011.
Methods A cohort study of 6,677 RA patients at working age identified in the nationwide DANBIO registry, a register on adult patients with inflammatory joint diseases, and 56,955 matched (age, gender, area of residence) controls from the general population. By linkage with the DREAM registry (a national registry on employment status and sick-leave) and other registries, we analyzed in a multi-state model all shifts between the work-related states simultaneously and calculated hazard rates (HR), stratified by disease duration (early RA (<1yr) and established RA (≥1yr)), controlled for socio-demographic factors, physical job exposure, somatic and psychiatric comorbidities.
Results The RA patients had increased risk of LTSA (e.g. early RA: HR=4.00) and disability pension (e.g. established RA: HR=2.75) relative to controls, see table. The relative risks of LTSA and disability pension decreased from 1994–99 to 2006–11 (e.g. in established RA: from work to LTSA HR 2.25 to 1.63, and from LTSA to disability pension HR 3.49 to 2.40). Compared to controls, RA patients had a lower chance of returning to work from LTSA (early RA: HR=0.60) or unemployment (early RA: HR=0.77), and this did not change over time.
Conclusions RA patients remain at high risk for LTSA and disability pension, but a positive trend is seen from 1996–1999 to 2006–2011. Returning to work from unemployment or LTSA remains a challenge for RA patients.
Disclosure of Interest S. Hansen: None declared, M. Hetland Consultant for: BMS, MSD, Pfizer, Abbott, UCB, Roche, J. Pedersen: None declared, M. Østergaard Consultant for: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Centocor, GSK, Hospira, Eli-Lilly, Janssen, Merck, Mundipharma, Novartis, Novo, Orion, Pfizer, Schering-Plough, Roche, Takeda, UCB, and Wyeth, T. Rubak: None declared, J. Bjorner: None declared