Studies Focus on Impacts of Arthritis on Employment

PEOPLE with arthritis may change work hours, the type and nature of their work or may lose their jobs due to disability related to their arthritis, according to research presented at the American College of Rheumatology Annual Scientific Meeting in Boston. Separate studies found that work factors, such as working few hours and being self-employed, continue to be the most important predictors of work disability and loss among patients with rheumatoid arthritis.

In the first study, researchers examined work transitions (changes to work hours, type and nature of work, and occasional work loss) made by 490 people with osteoarthritis (OA) and inflammatory arthritis (IA) over a four-and-a-half year period.

All participants completed an interview-administered, structured questionnaire with demographic, illness and disability, work transition, and psychosocial (such as depression, perceived workplace support, and job stress) components. Participants were interviewed four times, 18 months apart, to determine if any changes in employment or work situations were made.

During the course of the study, 63 percent of the participants remained employed; however, work transitions were common. Forty-five percent of participants reduced their hours worked to accommodate their arthritis. Fifty-two percent of participants changed their type of work, 18 percent were unable to seek and accept promotions and job transfers, and 41 percent were unable to take on additional responsibilities.

Participants also reported using vacation time, changing positions and missing work to deal with arthritis.

"We know that arthritis can result in people having to leave their jobs. This research focuses our attention on the workplace itself and highlights how common a wide range of work transitions are in the lives of people with arthritis," said Monique A.M. Gignac, Ph.D.; senior scientist, Toronto Western Research Institute; associate professor, Department of Public Health Sciences, University of Toronto. "By studying these changes we hope to identify those that allow people to remain employed longer, as well as types of transitions that signal problems that need to be addressed with early intervention and treatment."

Another goal of the study was to look in detail at a person's workplace -- the types of problems that create stress in working with arthritis; the types of job demands individuals are faced with; workplace support; and the strategies people themselves have come up with to manage arthritis and work.

"We've sometimes focused exclusively on the negative impact of arthritis on employment. With this research, we've also been learning from people with arthritis about their successes. That is essential in order for us to be able to design interventions to help people remain employed," Gignac said.

Rheumatoid Arthritis Studies

Drugs known as anti-TNF inhibitors are often prescribed to individuals with rheumatoid arthritis (RA), and they work by targeting and blocking the inflammation, and can help reduce pain, morning stiffness, and tender or swollen joints. To determine the effect of anti-TNF therapy on work disability and premature work loss in patients with RA, researchers conducted two studies.

The first study evaluated 8,082 patients with RA, who were employed when diagnosed with RA. Researchers followed participants for up to five and a half years -- as long as they remained under the age of 62.

At an average of 12.8 years after the onset of RA, 44 percent of the participants in this study were no longer employed, nearly 23 percent considered themselves disabled, and nearly 21 percent were receiving Social Security Disability.

Researchers determined that anti-TNF therapy was not positively or negatively associated with the risk of work disability. They did, however, find that other factors, such as college education (making participants more likely to remain working) and smoking (making participants more likely to experience work disability), had an impact.

During the second study, researchers wanted to determine if anti-TNF therapy can prevent premature work loss after controlling for differences among participants in demographics, disease severity and work factors.

Participants completed four surveys over three years in this study. All were employed and under the age of 64 at the time of the first survey. Forty-eight percent of the participants were using anti-TNF therapy.

In this study, 231 participants were not working from the time of the second survey on. They were compared with 722 participants who remained employed full time for the duration of the study. Factors associated with premature work cessation included working fewer hours, earning a lower income, and being self-employed -- along with older age and more severe disease.

As with work disability measured in the first survey, researchers determined that anti-TNF therapy had little to do with work loss in these patients with RA.

"Work disability is a major cost of rheumatoid arthritis, and it is hoped this cost will be reduced by anti-TNF therapy. However, these studies found no evidence that anti-TNF therapy reduces rheumatoid arthritis work disability," said Saralynn Allaire, ScD; professor of medicine, Boston University School of Medicine; and an investigator in both studies. "It may take longer to see the effects of this therapy on work disability, since it works best when used in the very first stages of disease, or more powerful treatments may be needed."

Monique A.M. Gignac: www.uhnresearch.ca/researchers/profile.php?lookup=2034

Saralynn Allaire: www.bumc.bu.edu/Dept/Content.aspx?PageID=5658&DepartmentID=353

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