Background/Purpose:  Biological therapy has been shown to have a positive effect on work outcomes, such as work participation and/or work disability in patients with chronic inflammatory rheumatic diseases. However, work outcomes are often dependent on contextual factors. Our objective is to specifically identify both the disease-related and contextual factors that impact work outcomes in patients with chronic inflammatory arthritis treated with biologics.

Methods: A systematic literature search was conducted using the Medline, Embase, two Cochrane, and CINAHL databases as well as hand searches from conference archives and clinicaltrials.gov to identify publications relating to chronic inflammatory rheumatic diseases (specifically rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic erythematous lupus (SLE), Sjogren’s syndrome, or systemic sclerosis (Ssc)) in double-blind, randomized-controlled biological therapy trials with work outcomes as a primary or secondary outcome. Only studies that describe a relationship between either a disease-related or contextual (CoFas) factor and work outcome were included. A critical appraisal of the included studies was performed to determine methodological flaws in the study design and to assess for possible bias.

Results:  Of the 1649 abstracts retrieved, 13 studies met inclusion criteria. The RCT’s included 3 chronic inflammatory diseases (AS= 3, PsA =2, RA = 8). The follow-up period was between 12 weeks to 2 years. Biologics used include etanercept (4 studies), infliximab (3 studies), adalimumab (3 studies), and single studies with golimumab, abatacept, and certolizumab pegol. Despite study heterogeneity, there was an overall positive effect of biological therapy on work outcomes. Disease-related factors which correlated with work outcomes included patient-reported outcomes such as the health assessment questionnaire (HAQ) in 7 studies, fatigue in 3 studies, and pain in 2 studies, as well as specific disease activity and remission markers. Only 6 studies examined contextual factors. Specifically, personal factors such as female gender (4 studies) and older age (4 studies) had a negative impact on work outcomes. Environmental factors that correlated with better work outcomes include non-manual type of jobs, higher baseline number of hours worked, and lower baseline number of sick days.

Conclusion:  Our results show that the positive effect of biological therapy on work outcomes is likely a result of interplay between better disease control as well as favorable patient and work environment contextual factors. Further trials identifying these variables will be important for the evaluation and prediction of work outcomes in RCT’s with biological therapy for patients with chronic inflammatory diseases.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-impact-of-disease-related-and-contextual-factors-on-work-outcomes-in-chronic-inflammatory-arthritis-patients-treated-with-biologics-a-systematic-review/