Background/Purpose:

The impact of ankylosing spondylitis (AS) on work status is substantial.  While the majority of studies focus on the prevalence of absenteeism in this group, impairment (i.e. presenteeism) whilst at work is also an important factor when assessing the impact of disease on work-life yet remains relatively understudied.  The aim of the current study was therefore to describe the prevalence of, and factors associated with, work impairment in AS.

Methods:

SIRAS collects data on clinically diagnosed AS patients in Scotland.  Clinical measures recorded from medical records include disease activity (BASDAI) and physical function (BASFI), while postal questionnaires provide patient-reported data including pain and fatigue (Chalder Fatigue Scale).  Work impairment ‘during the past 7days’ was assessed using the Work Productivity and Activity Impairment questionnaire – Specific Health Problem.  Logistic regression was used to identify potential clinical and patient-reported factors associated with work impairment.  These were assessed further using forward stepwise logistic models to identify independent risk factors.  Results are given as odds ratios with 95% confidence intervals.  Additionally, the population attributable risks associated with independent risk factors were calculated.

Results:

SIRAS contains both clinical and patient-reported information on 959 patients (male 73%, mean age 52yrs).  Of those who answered items on employment (n=946), 55% were currently working, and only 10% of workers had missed work (during the past 7days) due to their AS.  However, 71% of workers reported some impairment during this time (any versus none).  Factors independently associated with work impairment were: moderate/severe fatigue (4.8; 2.4-9.4), poor physical function (BASFI≥4: 2.6, 1.2-5.6) and chronic widespread pain (3.7, 1.9-7.3).  The population attributable risks associated with these factors were 19%, 9% and 13% respectively.

Conclusion:

The majority of employed AS patients did not report missing any work, in the previous week, due to their AS.  However, many experienced impairment whilst working, the key identifiable drivers of which were fatigue, pain and poor physical function.  Targeted, non-pharmacological treatments, such as cognitive behavioural therapy, in addition to traditional therapeutic targets, may help to improve overall work productivity.  This may reduce the economic impact of the disease and, ultimately, could improve overall work retention.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-impact-of-ankylosing-spondylitis-on-work-impairment-data-from-the-scotland-registry-for-ankylosing-spondylitis/