Background/Purpose: People with rheumatoid arthritis (RA) commonly have daily activity difficulties. Whilst biologics significantly improve ability, ergonomic methods (e.g. altered working methods, ergonomic equipment, activity and environment modification) may still  improve ability further. The aim of this study was to investigate activity limitations of people with RA on biologics and their use of ergonomic methods.

Methods: Participants on biologics completed the Evaluation of Daily Activity Questionnaire (EDAQ):  measuring ability performing 138 activities (grouped in 14 domains: Table 1). Activities are scored as 0 (no difficulty) to 3 (unable to do). Each is scored twice: Section A = ability without ergonomic methods or help; Section B (completed if difficulty) =ability with ergonomic methods (if used). Percentages of participants experiencing difficulties per activity (Section A) were calculated. Score differences between sections A and B were analysed using paired t-tests.

Results: Participants were recruited from 14 Rheumatology units (n=198: 156 women; 42 men). Mean age = 59.16 (SD 10.46) years; RA duration 13.83 (SD 9.24) years). Biologics prescribed were: etanercept (n=75); adalimumab (57); rituximab (44), infliximab (16), golimumab (3), certolizumab (1) and abatacept (1). Average pain was 4.69 (SD2.57) and fatigue 5.47 (SD2.47). Average HAQ score was 1.21 (SD 0.83).Participants rated their health as: very good (9%); good (29%); fair (42%); poor (16%) and very poor (4%).  Average EDAQ scores without ergonomic methods were at or below the lower tertile in all domains (Table 1).  Common difficulties included: opening jars (88%); carrying pans (82%); preparing vegetables (76%); using a kettle (68%); vacuuming (67%); turning taps (56%); preparing meals (49%). Average ability using ergonomic methods (section B) was significantly better for all domains, except Caring (as many had few childcare responsibilities due to their age). Ergonomic methods were used more by those rating health as fair, poor or very poor.

Conclusion: People with RA on biologics continued using ergonomic methods, reporting significantly better ability as a result. Section B scores indicated scope for greater use of ergonomic methods to further reduce limitations. Many on biologics might benefit from occupational therapy assessment and ergonomic advice to help further reduce limitations.

Table 1: EDAQ domain scores for people with RA on biologic drugs (n=198)

EDAQ Domain score	Domain score range	n	Section A Mean (SD)	Section B Mean (SD)	p
1.Eating/Drinking	0-30	187	10.47 (6.70)	8.21 (6.12)	<0.001
2. Bathroom	0-36	184	5.83 (5.80)	5.24 (5.49)	<0.001
3. Dressing	0-33	190	8.65 (7.30)	8.25 (7.10)	<0.001
4. Bathing	0-33	192	9.85 (8.36)	8.95 (7.86)	<0.001
5. Cooking	0-42	182	12.26 (9.69)	11.26 (9.63)	<0.001
6. Moving Indoors	0-36	180	10.38 (7.78)	9.81 (7.62)	<0.001
7. Cleaning	0-27	194	9.66 (7.15)	9.43 (7.19)	<0.001
8. Laundry	0-27	191	8.41 (7.31)	7.92 (7.17)	<0.001
9. Transfers	0-18	196	4.68 (3.71)	4.44 (3.64)	<0.001
10. Communication	0-18	192	3.15 (3.13)	2.83 (2.98)	<0.001
11. Moving Outdoors	0-39	182	11.86 (9.32)	11.12 (9.14)	<0.001
12. House / Garden maintenance	0-21	194	10.30 (7.08)	10.21 (7.08)	<0.001
13. Caring	0-27	189	3.99 (7.16)	3.97 (7.12)	0.1
14. Leisure	0-27	184	6.43 (6.26)	6.24 (6.29)	<0.001

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/activity-limitations-experienced-by-people-with-rheumatoid-arthritis-on-biologic-medications-and-their-use-of-ergonomic-methods/