Date: Sunday, November 7, 2021
Session Type: Poster Session B
Session Time: 8:30AM-10:30AM
Background/Purpose: Reduced work and activity productivity are significant contributors to the personal and societal costs associated with rheumatoid arthritis (RA). We sought to describe work productivity in newly diagnosed RA patients and to identify predictors of impaired productivity over time in patients managed according to contemporary treatment strategies.
Methods: Data were from working age, early RA patients (18-64 years; < 1 year of symptoms at baseline), followed by rheumatologists across Canada and treated with disease modifying anti-rheumatic drug therapies (DMARDs) according to Treat-2-Target guidelines. Between Nov 2011 and March 2020, participants reported baseline work status (employed, unemployed, retired) and annual work productivity was assessed using the Work Productivity and Activity Index (WPAI). WPAI scores for overall work productivity loss with subscores for absenteeism (time away from work) and presenteeism (reduced productivity at work) and scores for reduced general activity are expressed as impairment percentages (%) with higher numbers indicating greater impairment and less productivity. We used generalized estimating equations (GEE) to estimate associations between change in WPAI scores over the first five years of follow-up with time varying lagged disease activity (DAS28 at previous visit predicting WPAI at the next visit), while adjusting for baseline variables of age, sex, work commitment (full time; part-time) and comorbidity [Rheumatic Disease Comorbidity Index (RDCI; range 0-9); depression], and time-varying lagged therapy use (Methotrexate (MTX), biologic DMARDs/ JAKi, prednisone) at the previous visit.
Results: At baseline, of 673 working age RA patients, 434 (65%) were employed [352 (82%) full time], 159 (24%) were unemployed and 74 (11%) were retired. Employed RA patients were mainly female (75%), Caucasian (81%), had some education beyond high school (68%) and had active RA with mean (SD) baseline DAS28 4.7(1.4) and mHAQ 0.5(0.5). At baseline, employed RA patients reported on average (SD) 39.8% (29.8) overall work impairment [absenteeism 8.4% (18.6); presenteesim 37.0 % (28.0)] and non-work activity impairment due to health of 43.5% (28.5). Work productivity scores improved after 1 year follow-up but remained relatively stable thereafter (Figure). In lagged multivariable GEE models, higher DAS28 was associated with more work impairment over time; mean change (95% confidence interval) in overall work impairment 7.1% (6.2, 7.9), absenteeism 1.9% (1.4, 2.5), presenteeism 6.6% (5.8, 7.4) and activity impairment 7.8% (7.1, 8.6). Baseline comorbidity was also associated with overall work impairment over time [RDCI mean change 1.9 % (0.1, 3.6); depression mean change 8.0 % (0.4, 15.7].
Conclusion: Patients with early RA report nearly 40% reduced work productivity, mainly from reduced effectiveness while at work, and have similar impairment in non-work activities. While work and activity productivity improve with treatment, persistent disease activity contributes to productivity impairment over time. Interventions to optimize continued engagement in work and addressing difficult to treat RA may improve productivity outcomes for RA patients and their employers.
To cite this abstract in AMA style:Hitchon C, Valois M, Schieir O, Bartlett S, Bessette L, Boire G, Hazlewood G, Keystone E, Pope J, Thorne C, Tin D, Bykerk V, (CATCH) Investigators C. Persistent Disease Activity Impairs Work Productivity and Non-work Activity in Recent Onset Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 10). https://acrabstracts.org/abstract/persistent-disease-activity-impairs-work-productivity-and-non-work-activity-in-recent-onset-rheumatoid-arthritis/. Accessed January 24, 2022.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/persistent-disease-activity-impairs-work-productivity-and-non-work-activity-in-recent-onset-rheumatoid-arthritis/