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Predictors of work disability after start of anti-TNF therapy in a national cohort of Swedish patients with rheumatoid arthritis: does early anti-TNF therapy bring patients back to work?
  1. T Olofsson1,
  2. I F Petersson2,
  3. J K Eriksson3,
  4. M Englund2,
  5. J A Nilsson1,
  6. P Geborek1,
  7. L T H Jacobsson4,
  8. J Askling3,
  9. M Neovius3
  10. for the ARTIS Study Group
    1. 1 Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
    2. 2 Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
    3. 3 Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
    4. 4 Department of Rheumatology and Inflammation, Research Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
    1. Correspondence to Dr T Olofsson, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund SE-221 85, Sweden; torolofsson{at}


    Objectives To examine predictors of work ability gain and loss after anti-tumour necrosis factor (TNF) start, respectively, in working-age patients with rheumatoid arthritis (RA) with a special focus on disease duration.

    Methods Patients with RA, aged 19–62 years, starting their first TNF inhibitor 2006–2009 with full work ability (0 sick leave/disability pension days during 3 months before bio-start; n=1048) or no work ability (90 days; n=753) were identified in the Swedish biologics register (Anti-Rheumatic Treatment In Sweden, ARTIS) and sick leave/disability pension days retrieved from the Social Insurance Agency. Outcome was defined as work ability gain ≥50% for patients without work ability at bio-start and work ability loss ≥50% for patients with full work ability, and survival analyses conducted. Baseline predictors including disease duration, age, sex, education level, employment, Health Assessment Questionnaire, Disease Activity Score 28 and relevant comorbidities were estimated using Cox regression.

    Results During 3 years after anti-TNF start, the probability of regaining work ability for totally work-disabled patients was 35% for those with disease duration <5 years and 14% for disease duration ≥5 years (adjusted HR 2.1 (95% CI 1.4 to 3.2)). For patients with full work ability at bio-start, disease duration did not predict work ability loss. Baseline disability pension was also a strong predictor of work ability gain after treatment start.

    Conclusions A substantial proportion of work-disabled patients with RA who start anti-TNF therapy regain work ability. Those initiating treatment within 5 years of symptom onset have a more than doubled 3-year probability of regaining work ability compared with later treatment starts. This effect seems largely due to the impact of disease duration on disability pension status.

    • Anti-TNF
    • Rheumatoid Arthritis
    • DMARDs (biologic)
    • Social work
    • Outcomes research

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    • Handling editor Tore K Kvien

    • Collaborators The ARTIS Study Group: J Askling (Karolinska Institutet), E Baecklund (Uppsala University), S Ernestam (Karolinska Institutet), N Feltelius (Medical Product Agency), H Forsblad-d'Elia (Sahlgrenska Academy), L Jacobsson (Sahlgrenska Academy), A Kastbom (Linköping University), L Klareskog (Karolinska Institutet), E Lindqvist (Lund University), S Rantapaa-Dahlqvist (Umeå University), C Turesson (Lund University), R van Vollenhoven (Karolinska Institutet).

    • Contributors TO, MN, IP, LTHJ, PG, JA and ME planned the study. JKE and MN provided the data. TO and MN performed the analysis and drafted the paper. All the other authors contributed to editing the draft for content and approved of the final version. All authors had full access to all the data (including statistical reports and tables) in the study and take responsibility for the integrity of the data and accuracy of the data analysis.

    • Funding This study was funded by unrestricted grants from Lund University and Region Skåne. For the maintenance of the Swedish Biologics Register (ARTIS), the Swedish Society for Rheumatology has received funding, independent of the conduct of these scientific analyses, from Merck Sharp and Dohme, Bristol-Myers Squibb, Pfizer, AbbVie, SOBI, Union Chimique Belge Pharma, AstraZeneca and Roche.

    • Competing interests JA has research agreements (mainly for commissioned safety monitoring in ARTIS) with UCB, Roche, Merck, Pfizer, Samsung, Lilly and Abbvie, and has received remuneration for an ad board organised by Lilly. JKE has participated in research projects fully or partly funded by Novo Nordisk and COMBINE Sweden and served as an external consultant to AbbVie. MN has participated in advisory boards for Pfizer (rheumatology) and Abbott (non-rheumatology) and in research projects fully or partly funded by Schering-Plough, AstraZeneca, Novo Nordisk, Pfizer and Roche (unrelated to the current work). LTHJ has received fees for speaking and consultancy from Pfizer, Novartis, Abbvie and Celgene. IFP has reported ownership of options in Ana Mar.

    • Ethics approval The Ethics Committee at Karolinska Institutet.

    • Provenance and peer review Not commissioned; externally peer reviewed.