‘Holistic approach’ needed to improve work life of RA patients
medwireNews: Multiple factors, such as functional ability and treatment response, influence the likelihood of job loss and absenteeism by patients with rheumatoid arthritis (RA) who are treated with methotrexate or biologic DMARDs, study findings indicate.
“Therefore, a holistic approach combining both good control of disease activity and interventions aiming to address the other salient predictors including reducing physical demands and increasing support at work, and improving disability and fatigue, may be required to further improve the work participation” of these patients, comment the study authors in Rheumatology.
Using data from the UK-based RAMS and BRAGGSS cohorts that included 463 RA patients who started taking methotrexate from 2008 and 260 patients who initiated biologic DMARDs from 2012, the team found that 11.0% and 11.5%, respectively, terminated employment after 12 months. Additionally, on average 16.6% and 14.9% of patients in the respective treatment groups reported at least one sickness-related work absence in the month prior to each follow-up – after 6 and 12 months of treatment.
Presenteeism, defined as a reduction in job performance, remained low when work productivity was measured on a scale of 0–10.
Multivariate analysis revealed that the likelihood of a patient leaving work was independently associated with their functional ability, such that every unit increase in HAQ-DI score was associated with a 1.55-fold and 3.46-fold rise in the likelihood of job loss for patients in the methotrexate and biologic DMARD groups, respectively.
Patients with higher HAQ-DI scores were also more likely to report sick leave, with the odds increasing 1.46- and 2.41-fold for every unit increase in the HAQ-DI score among methotrexate- and biologic DMARD-treated patients, respectively.
By contrast, a good EULAR response in the first 6 months was associated with reduced odds for absenteeism in both the methotrexate and biologic DMARD groups, with respective odds ratios (OR) of 0.23 and 0.36 versus no response. And among those who received methotrexate, there was a similar association between a moderate EULAR response and absenteeism, with an OR of 0.36 versus no EULAR response.
Other factors associated with job loss and absenteeism in the treatment groups included psychologic distress, current smoking, and fatigue.
The researchers believe that “[t]hese factors may be useful in identifying patients who are at increased risk of having poor work-related outcomes.”
And they conclude that “[t]argeted referral to interventions aiming to address important areas influencing patients’ personal ability to work (e.g. disability, fatigue, psychological distress) for patients at high risk of job loss may be the next step towards improving work participation amongst patients with RA.”
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