Background/Purpose

Historical data ⁽¹⁾indicate a third of patients with RA are unable to work within the first 5 years of diagnosis. Our aim was to quantify work disability in an inception cohort of patients with early (<12 months) RA (fulfilling ACR 1987 revised classification criteria) receiving treat-to-target combination DMARD therapy. 

Methods

Patients received initial triple therapy (methotrexate, sulfasalazine and hydroxychloroquine) with escalation (using other DMARDs or biologic DMARDs) to achieve DAS28(ESR) remission. Patients completed an annual validated work and arthritis questionnaire. Random effect mixed modelling was used to assess associations between the primary outcome, average hours worked per week, and baseline prognostic factors, with subject entered as a random effect to account for correlated observations. Hours worked per week (HWPW) were compared with age, gender and period matched population averages.

Results

There were 541 observations on 139 patients. Patients were included in the analysis if they had complete data and were working at any time point, that is, those with at least one positive value for hours worked; this included 67 patients with 313 observations. The mean (SD) age at disease onset was 42.8 (11.0) years; 55/67 (82%) were women; median (IQR) duration of polyarthritis was 16 (12-28) weeks. The median (IQR) follow up time was 3 (2.0-5.2) years.  At baseline, the proportion of patients in work at baseline was 67% and this did not significantly change with time (73% at the end of the follow-up period).

Males worked more hours; there was no significant loss of working hours over the mean follow-up period (Table 1).  Anti-cyclic citrullinated peptide antibody positivity was associated with loss of working hours; there was no relationship between baseline or area-under-the-curve DAS28 and HAQ and working hours lost. When examined by profession 50% working as labourers on enrolment gave up work on follow up as compared to only 7% of those in managerial roles. For the matched population averages HWPW increased by 3.7 over a comparable follow-up period (p=0.001).

Table 1.

	p-value
Males worked 14.5 (95% CI 6.4, 22.6) hours/ week more than females	<0.001
Patients with anti-cyclic citrullinated peptide (CCP) positivity were more likely [7.4 (95%CI 1.3, 13.7)] to reduce working hours	0.017
Loss of working hours over mean follow-up period was 0.85 (95%CI -1.65, 3.4)	0.52

Conclusion

In contrast to the era before the advent of more intensive treatment approaches, a treat-to-target strategy mainly using conventional DMARDs preserves work capacity in patients with RA over the first few years of disease. Patients with ACPA or in manual labouring roles were more likely to reduce working hours.

⁽¹⁾ Barrett EM et al. Rheumatology 2000;39:403-09.

---

« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-treat-to-target-strategy-preserves-work-capacity-in-early-rheumatoid-arthritis-ra/