Background/Purpose: Rheumatoid arthritis (RA) is associated with restrictions on occupational participation caused by periods of sick leave (absenteeism), reduced productivity at work due to disease (presenteeism) and occupational disability, which account for a significant proportion of indirect costs. We investigate the prevalence and development of occupational participation with a sole focus on absenteeism and employment after drug therapy intervention.

Methods: Data from the multi-center German study “Effectivity of nurse-led care” which examined patients with rheumatoid factor and/or APCA-positive RA after T2T regimen prospectively over 12 months from 01/2018 to 12/2019 were analyzed. A total of 178 patients of working age (18 to 67 years) were included in this evaluation. Disease activity presented through DAS28(CRP) and ability to work measured by the Work Productivity and Activity Impairment Questionnaire (WPAI) were examined at baseline and month 12.

Results: The mean age of the patients was 54 years (median 55; standard deviation (SD) 9.01) and 133 (74.3%) of the patients were female. During the course of the study, there was a significant decrease in DAS28 from 4.27 (SD 1.13) at baseline to 2.52 (SD 1.09; p< 0.001) after 12 months. At the end of the study 63% of the patients were in remission (DAS28< 2.6) and 11.2% had low disease activity (DAS28 2.6-3.2). At baseline, 38.8% (n=69) and at the end of the study 41.9% (n=67) of patients were not working. Of the working population, 34.7% were in part-time employment (< 32 hours per week) at baseline and 35.6% at 12 months. The weekly working time also remained almost unchanged during the course of the study, with 29.5 hours (median 32) at baseline and 30.8 hours (median 33) at 12 months. Of those working full-time (n=89), 31.5% (n=14) were absent at the beginning of the study, which tended to decline to 19.1% (n=17) at month 12 (p=0.089). In patients with absenteeism, sickness-related absence from work accounted for 47.6% (SD: 36.8) of total working hours at baseline and 73.5% (SD: 30.03) at the end of the study. Patients with no restrictions on occupational participation showed a significantly greater drop in DAS28 from 3.99 (SD 0.99) at baseline to 2.14 (SD 0.90) at baseline than patients with restrictions (DAS28 4.42 (SD 1.14) at baseline to 2.69 (SD 1.12) at baseline; p< 0.001).

Conclusion: Despite T2T and good therapeutic effect according to DAS28, there are clear and persistent limitations in occupational participation. Patients with restricted occupational participation show a significantly increased disease activity. To reduce indirect costs in RA, further optimization of disease management is necessary.

The research leading to these results has received funding from the German Innovationsfunds, Agreement No 01NVF16029.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/substantial-work-limitations-in-patients-with-rheumatoid-arthritis-despite-optimal-treat-to-target-t2t-drug-therapy-intervention/