Background/Purpose:Rheumatoid
arthritis (RA) is a known cause of work productivity loss. The goal within
rheumatology today is to diagnose RA as soon as possible, to allow for early and
aggressive treatment aiming for remission and sustained levels of daily
activities. The objective of the current study was to assess work participation
in an early, untreated RA cohort, and assess if work productivity differed
across groups of patients according to disease activity.

Methods: Consecutive RA patients who fulfilled the 2010 ACR/EULAR classification criteria were recruited between
October 2010 and April 2013. All patients had symptom duration <2 years from
first swollen joint, and were disease modifying anti-rheumatic drug (DMARD)
na•ve with indication for DMARD treatment at time of inclusion. The data
collection included clinical examination, patient
reported outcome measures (e.g. Work Productivity and Activity Impairment
Questionnaire, WPAI) and laboratory assessment. We
used data from WPAI and additional information on
work participation to assess absenteeism (work time missed), presenteeism (impairment while at work) and overall work
productivity loss (absenteeism plus presenteeism) due
to RA. We then compared work participation across disease activity groups by
Mann-Whitney U-test or chi-square test as appropriate.

Results: A
total of 233 patients were included with median (25^th percentile, 75^th percentile) age 53.9 (41.7,
62.5) years, median disease duration from first swollen joint 5.7 (2.8, 10.2)
months, 61.8 % female gender and 82.0% anti-citrullinated
protein antibody (ACPA) positivity. 176 patients
(75.5%) reported current employment (Table).
Patients not reporting employment were retired (49.1%), on disability pension
(19.3%) or unemployed for other reasons (31.6%). Although employed patients
overall had limited absenteeism and moderate work productivity loss, patients
with high disease activity had higher levels of absenteeism (median 71.4% vs 0.0%, p-value<0.001), presenteeism
(40.0% vs. 10.0%, p-value < 0.01) and had impaired overall work productivity
(85.7% vs. 50.0%, p-value <0.001) compared to patients in low disease
activity (Table). There were no
significant differences between groups with regards to age, gender, ACPA positivity and disease duration.

Conclusion: Newly diagnosed DMARD-na•ve RA patients on average
had low levels of absenteeism, but about half the patients had work impairment
due to either absenteeism or presenteeism. Patients
with high disease activity had higher levels of absenteeism, presenteeism and overall work impairment than patients with
low disease activity. The data suggest that the 2010 ACR/EULAR classification criteria might capture RA patients
with short symptom duration before significant loss of work productivity, but
that even in this group many patients have already experienced work impairment
due to their disease.