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Long-term work disability in patients with psoriatic arthritis treated with anti-tumour necrosis factor: a population-based regional Swedish cohort study
  1. Lars Erik Kristensen1,2,3,
  2. Martin Englund1,4,
  3. Martin Neovius5,
  4. Johan Askling5,
  5. Lennart T H Jacobsson6,
  6. Ingemar F Petersson1,2,3
  1. 1Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
  2. 2Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden
  3. 3Department of Rheumatology, Skåne University Hospital, Lund, Sweden
  4. 4Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Massachusetts, USA
  5. 5Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
  6. 6Department of Inflammation Research and Rheumatology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
  1. Correspondence to Dr Lars Erik Kristensen, Department of Rheumatology, Skåne University Hospital, Lund SE-221 85, Sweden; larserik_kristensen{at}yahoo.com

Abstract

Objective To study long-term work disability before and after tumour necrosis factor (TNF)-antagonist therapy in patients with psoriatic arthritis (PsA).

Methods Using the population-based South Swedish Arthritis Treatment Group Register, we identified 191 patients with PsA (median age 43 years, range 18–58 years, 54% men), who between January 2003 and December 2007 started treatment with adalimumab, etanercept or infliximab. We linked data to the Swedish Social Insurance Agency and calculated the proportion of work disability in 30-day intervals from 12 months before the start of treatment until 3 years after. For each patient with PsA we randomly selected four matched reference subjects from the general population.

Results At treatment initiation 67% of the patients with PsA were work disabled—that is, either on sick leave (41.5%) or receiving a disability pension (25.3%). Patients sustaining treatment were, on average, work disabled 12.5 days a month at treatment initiation declining to 10.6 days a month after 3 years of treatment. Patients for whom the first treatment course failed were work disabled 16.5 days at treatment start decreasing to 15.6 days after 3 years. The background population were 2.5 days and 3.0 days off work each month, respectively. Regression modelling identified prior work disability status, anti-TNF treatment failure, higher age, female gender and longer disease duration as significant predictors of working disability.

Conclusions There was a decline in net work disability after initiation of anti-TNF treatment in patients with PsA. Patients withdrawing from treatment had a 50% increased risk of being work disabled. Prior work disability, higher age, female gender and longer disease duration were also associated with long-term work disability.

  • Psoriatic Arthritis
  • TNF-alpha
  • Anti-TNF
  • Economic Evaluations
  • Epidemiology

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