Background Ten years ago rheumatoid arthritis (RA) was associated to extensive sick leave during the years after diagnosis despite early instituted disease modifying anti rheumatic drugs (DMARD:s) (1). Since then the treatment strategies have undergone big changes and biological agents have been introduced.
Objectives To compare sick leave in early RA today compared to10 years ago.
Methods 320 patients were included in the Swedish early RA cohort (TIRA1) during 1996-1998 and 522 patients were included 2005-2008 in the TIRA2 cohort. The prescription of traditional DMARD:s was more frequent in TIRA2 already at inclusion but there were no differences in DAS28 between two cohorts that timepoint. The 120 patients (76% women) that were still participating in TIRA1 at 2-year follow-up and that were ≤ 64 years were included in the present study together with the corresponding 275 patients (74% women) in TIRA2. Sick leave data (sickness benefit and disability pension) were obtained for patients one year before until two years after inclusion (diagnosis).
Results One year before diagnosis 20% in TIRA1 and 18% in TIRA2 were on sick leave. Until time for inclusion this number increased to 50% in TIRA1 and 39% in TIRA2. At one year after inclusion much fewer were on sick leave in TIRA2 (30%) than in TIRA-1 (51%). After two years, sick leave in TIRA2 was further reduced to 28% which differs vastly from TIRA1, where the sick leave increased to 54%.
The mean days of sickness benefit and disability pension during the year before diagnosis were 42 and 24 respectively in TIRA1 compared to 31 and 35 in TIRA2. During the year after diagnosis, the mean days of sickness benefit and disability pension were 93 and 33 in TIRA1, and 59 and 36 in TIRA2. During the second year the corresponding figures were 72 and 66 days in TIRA 1 versus 35 and 41 days in TIRA2.
Conclusions The far lower sick leave rate seen today after a diagnosis of RA, compared to the situation 10 years ago, cannot be explained by differences in sick leave during the year before diagnosis. Although sick leave is lower today, the sick leave rate in TIRA2 is still high compared to the general population. This highlights a need to develop efficient multiprofessional intervention strategies in addition to modern anti-rheumatic pharmacotherapy regimens.
Björk M, Thyberg I, Rikner K, Balogh I, Gerdle B. (2009). Sick leave before and after diagnosis of rheumatoid arthritis: a report from the Swedish TIRA project. J Rheumatol; 36:1170-1179.
Disclosure of Interest None Declared
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