How Do Clinical and Socioeconomic Factors Impact on Work Disability in Early Axial Spondyloarthritis? Five-year Data from the DESIR Cohort

Elena Nikiphorou¹, Annelies Boonen², Bruno Fautrel³, Pascal Richette⁴, Robert Landewé⁵, Désirée van der Heijde⁶ and Sofia Ramiro¹, ¹Leiden University Medical Center, Leiden, Netherlands, ²Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+ (MUMC+), Maastricht, Limburg, Netherlands, ³Pitié Salpêtrière Hospital, APHP, Sorbonne Université, Paris, France, ⁴Lariboisiere Hospital, Paris, France, ⁵Amsterdam Rheumatology & Clinical Immunology Center, Amsterdam, Netherlands; Zuyderland MC, Heerlen, Netherlands, ⁶Department of Rheumatology, Leiden University Medical Center, Meerssen, Netherlands

Meeting: ACR Convergence 2021

Keywords: Epidemiology, spondyloarthritis

Session Information

Date: Saturday, November 6, 2021

Title: Spondyloarthritis Including PsA – Diagnosis, Manifestations, & Outcomes Poster I: Clinical Aspects of Axial Spondyloarthritis (0357–0386)

Session Type: Poster Session A

Session Time: 8:30AM-10:30AM

Background/Purpose: There remains substantial unmet need to study work disability (WD) in early axSpA. Previous studies suggest that treatment interventions alone do not improve work outcomes and that socioeconomic (SE) as well as clinical factors may play an important role.

Methods: Patients from the DESIR cohort with a clinical diagnosis of axSpA were studied over 5 years. Time to WD and potential baseline and time-varying predictors were explored, with a focus on socioeconomic (including ethnicity, education, job-type, marital/parental status) and clinical (including disease activity, function, mobility) factors. Univariable analyses, collinearity, and interaction tests guided subsequent multivariable time-varying Cox survival analyses.

Results: From 704 patients eligible for this study, the estimated incidence of WD amongst those identified at-risk (n=663, 94%) and across the five-years of DESIR, was 0.05 (95% CI 0.03-0.06) per 1000 days. Significant differences in baseline socioeconomic factors, including lower educational status and clinical measures, including worse disease activity, were seen in patients developing WD over follow-up, compared to those who never did. In the main multivariable model, educational status was no longer predictive of WD, whereas the Ankylosing Spondylitis (AS) disease activity score (ASDAS) and the Bath AS functional index (BASFI) were significantly and independently associated with a higher hazard of WD (HR[95%CI] 1.79[1.27-2.54] and 1.42[1.22-1.65], respectively).

Conclusion: WD was an infrequent event in this early axSpA cohort. Nevertheless, clinical factors were amongst the strongest predictors of WD, over socioeconomic factors, with worse disease activity and function independently associated with a higher hazard of WD. Disease severity remains a strong predictor of adverse work outcome even in early disease, despite substantial advances in therapeutic strategies in axSpA.

Disclosures: E. Nikiphorou, Celltrion, 1, Pfizer, 1, 6, Sanofi, 1, Gilead, 1, AbbVie, 1, 6, Lilly, 1, 6, Galapagos, 6; A. Boonen, None; B. Fautrel, AbbVie, 5, Pfizer, 5, Janssen, 2, Medac, 2, Novartis, 2, Sanofi-Genzyme, 2, Roche, 2, UCB, 2, Abbvie, 2, Amgen, 2, Biogen, 2, BMS, 2, Celltrion, 2, Fresenius Kabi, 2, Galapagos, 2, Gilead, 2, Lilly, 2, 5, MSD, 2, MSD, 5, Mylan, 2, Nordic Pharma, 2, Pfizer, 2, Sandoz, 2, SOBI, 2; P. Richette, AbbVie, 1, 6, Amgen, 1, 6, Celgene, 1, 6, Janssen, 1, 6, Eli Lilly, 1, 6, MSD, 1, 6, Novartis, 1, 6, Pfizer, 1, 6, UCB, 1, 6; R. Landewé, AbbVie, 5, 6, Novartis, 5, 6, Pfizer, 5, 6, UCB, 5, 6, Astra-Zeneca, 6, Bristol Myers Squibb, 6, Celgene, 6, Eli-Lilly, 6, Janssen, 6, Gilead, 6, Galapagos, 6, Glaxo-Smith-Kline, 6; D. van der Heijde, AbbVie, 2, Amgen, 2, Astellas, 2, AstraZeneca, 2, Bayer, 2, BMS, 2, Boehringer Ingelheim, 2, Celgene, 2, Cyxone, 2, Daiichi, 2, Eisai, 2, Eli Lilly, 2, Galapagos, 2, Gilead, 2, GlaxoSmithKline, 2, Janssen, 2, Merck, 2, Novartis, 2, Pfizer, 2, Regeneron, 2, Roche, 2, Sanofi, 2, Takeda, 2, UCB Pharma, 2, Imaging and Rheumatology BV, 4; S. Ramiro, AbbVie, 2, Eli Lilly, 2, MSD, 2, Novartis, 2, Sanofi, 2, UCB, 2, MSD, 5.

To cite this abstract in AMA style:

Nikiphorou E, Boonen A, Fautrel B, Richette P, Landewé R, van der Heijde D, Ramiro S. How Do Clinical and Socioeconomic Factors Impact on Work Disability in Early Axial Spondyloarthritis? Five-year Data from the DESIR Cohort [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/how-do-clinical-and-socioeconomic-factors-impact-on-work-disability-in-early-axial-spondyloarthritis-five-year-data-from-the-desir-cohort/. Accessed .

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