Background/Purpose: A number of studies have demonstrated the association between disease activity and work productivity in patients (pts) with RA. However, the relationship between work status and poor prognosis is unknown. This analysis characterized the proportion of pts with RA who had poor prognoses in an observational clinical cohort and evaluated poor prognostic factors and pts’ work status.

Methods: Using the Corrona RA registry, we identified pts with RA who were biologic naïve at enrollment and had a follow-up visit at 12 months (± 3 months). Pts were characterized by RA prognosis based on factors from the 2008 ACR treatment recommendations,¹ including functional limitation (modified Health Assessment Questionnaire), extra-articular disease (Sjögren’s syndrome, RA lung disease and/or nodules), seropositivity (RF and/or anti-cyclic citrullinated peptide antibodies) and erosions. Pts were categorized as having 0–1, 2 or 3+ poor prognostic indicators. Pts with missing information on any factor were excluded. Each of the three prognosis groups was compared at enrollment (including use of prior conventional synthetic DMARDs) according to use of TNF inhibitors vs non-TNF inhibitors. The relationship between poor prognosis category and work status was investigated at baseline and 12 months using a chi-squared test. A dichotomous variable was constructed, with working ‘yes’ defined as full- or part-time working, and working ‘no’ including pts who worked from home or were students, disabled or retired. Because a relationship between poor prognosis and work status might be driven by age differences (retirees are generally older), a frequency-matching approach was used to match people across poor prognosis categories according to age group (18–44, 45–54, 55-64, 65–74, 75+ years).

Results: 3621 pts who enrolled in Corrona on/after January 2005 met the selection criteria: 1554 (42.9%), 1263 (34.9%) and 804 (22.2%) with a prognosis category of 0–1, 2 or 3+, respectively. Pts in the worst prognostic category were older (median age: 62 vs 58 years), had more established disease (median disease duration: 4 vs 1 years) and greater disease activity (median CDAI score: 14 vs 7) compared with those in the best prognosis category. After adjusting for age, there was a significant relationship between work and poor prognosis category; pts in the worst prognosis category were less likely to be in full- or part-time work at enrollment compared with those in the best prognosis category (p<0.001; Table). At the 12-month visit, the relationship between poor prognosis category and work status remained statistically significant (p<0.001; Table).

Conclusion: These data suggest that the proportion of pts with RA in full- or part-time employment was lower in those with poor prognostic factors. Further studies are needed to investigate whether treatment can prevent or reverse impairment of work status in pts with RA. 1. Saag K, et al. Arthritis Rheum 2008;59:762–84.