Background Axial spondyloarthritis (axSpA) mainly affects the working-age subject and can have a moderate (short-term sick leave) or significant (long-term sick leave, disability status, unemployment) work impact.
Objectives To evaluate the value of a simple and short (2 minutes) questionnaire, the AS-Work instability scale (AS-WIS) to predict the work impact of axSpA after 1–2 years.
Methods Longitudinal study in 3 centers in Paris, France. Patients with axSpA according to the rheumatologist and the ASAS criteria were included. Patients were asked twice (1 to 2 year interval) to answer questionnaires evaluating: disease activity, demographic characteristics, impact on work (short-term and long-term sick leave, disability, unemployment), and the ASWIS questionnaire (1): a 20 item, simple screening tool for Work Instability (the consequences of a mis-match between an individual's functional ability and their work tasks). The risk of disability is assessed as low if the score is <11, medium between 11–18 and high>18. Only patients who answered both questionnaires were included for analyses. Statistical analyses included descriptive analyses and univariate/ multivariate analyses to search for baseline factors of work impact at 1–2 years (including a medium/high ASWIS score, gender, age, schooling level, BASDAI, BASFI).
Results Among the 188 patients who answered the first questionnaire, 144 were currently working and were asked to answer the second questionnaire. A total of 101 patients answered both questionnaires. Mean age at inclusion was 45 (SD 9) years, 52% were male, disease duration was 14 (SD 8) years and 62% had an education level equivalent to more than high school. The BASDAI and the BASFI were respectively 34 (SD 21) and 23 (SD 23). At baseline, median ASWIS was 10, a low-risk score was found in 55 patients (54%), and a medium/high risk score in 46 (46%).
1 -2 years later, 37 patients (36%) had work impact: 25 patients (25%) a short-term sick leave, and 12 patients (12%) a significant work impact (long-term disability or unemployment due to Ax-SpA).
Among patients with a low ASWIS score at baseline (n=55), only 13 (24%) had a work impact (including only 2 with a significant impact). Among patients with a medium/high ASWIS score (n=46), 24 (52%) had a work impact (including 10 patients of a significant impact).
In univariate analysis, baseline factors associated with work impact (moderate or significant) were a medium/high ASWIS score, a high BASFI and a shorter disease duration. In multivariate analysis, medium/high ASWIS (odds ratio, OR 2.71 (1.04–7.22)) and a lower disease duration (0.94 (0.89–0.99)) were independent predictive factors of work impact.
Conclusions In patients with axSpA, a medium/high ASWIS score was followed by a work impact in 50% of cases within 2 years in this well-controlled population. This short questionnaire can be helpful to screen for future difficulties at work, whatever the stage of disease.
Gilworth G, et al. Reducing work disability in ankylosing spondylitis: development of a work instability scale for AS. BMC Muskuloskelet Disorders 2009 Jun 16;10:68.
Disclosure of Interest None declared