Background/Purpose:

Clinical subsets of spondyloarthitis (SpA), such as ankylosing spondylitis (AS) and psoriatic arthritis (PsA) may be associated with significant impact on work performance and attendance.  Prior to becoming completely work disabled, patients will commonly experience a state of work instability (WI).  Our purpose was to determine the characteristics of WI in a large population of patients with SpA.

Methods:

Patients were recruited from two large, prospective longitudinal cohorts of AS and PsA.  WI was evaluated using a validated questionnaire, the AS-WIS.  Standard protocols were completed at the time of completion of the AS-WIS which included a detailed history, physical examination, physician-ascertained outcome measures and patient-reported outcomes.

Results:

718 respondents completed the questionnaire, 505 of which were employed at the time and included in the analysis.  Mean age was 45.5 years (SD 11.8) and 69.3% were male.  60.4% had completed university.  63.3% were being treated with NSAIDs, 33.6% DMARDs and 54.1% TNF inhibitors.  Mean swollen joint count was 0.08 (SD 0.40), tender joint count 0.85 (SD 2.76) and damaged joint count 3.47 (SD8.44).  Mean AS-WIS score was 7.0 (SD 6.0), corresponding to low risk of work instability. AS-WIS scores were equally low  in AS, non-radiographic axial SpA (nr-axSpA) and undifferentiated SpA (uSpA).  AS-WIS scores in PsA were significantly lower than in AS, nr-axSpA and uSpA (p<0.01 for each).  Higher AS-WIS were significantly associated with female gender, lower education level, higher tender joint count, current NSAID use, history of GI disease, history of CNS disease, and history of peripheral arthritis, enthesitis or dactylitis.  TNF inhibitor use was not associated with higher WIS scores. Multinomial logistic regression showed that the groups at the highest risk of WI were those with GI history, peripheral arthritis, enthesitis and dactylitis history.  All patient-reported outcome measures correlated highly with AS-WIS.

Conclusion:

In axSpA, WI was low, and was comparable for AS, nr-axSpA and uSpA. PsA was found to have significantly lower WI than these subsets of ax-SpA, however, in this cohort, PsA was well controlled with low joint counts, which may have impacted the WIS scores. Female gender, history of GI, CNS or peripheral disease and NSAID use was associated with greater WI.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/work-instability-scores-in-ankylosing-spondylitis-and-non-radiographic-axial-spondyloarthritis-are-equal-and-higher-than-in-psoriatic-arthritis/