Background/Purpose: Treatment resistant psoriatic arthritis (PsA) may render a patient unwell, disabled and incapable of work with previous reports suggesting that unemployment levels among PsA patients range from 30-50%, higher than the current national unemployment level of 14.7%. It is argued that the clinical, functional and quality of life benefits of tumour necrosis factor α inhibitor drugs (TNFi) may not be sufficient to justify their significant economic cost (national cost, >€100 million/year in 2010). We sought to evaluate longitudinal employment levels among PsA patients treated with TNFi therapy.   

Methods: A prospective cohort study of TNFi treated PsA patients between the ages of 18-65 fulfilling the ClASsification of Psoriatic ARthritis (CASPAR) criteria with active disease despite DMARD therapy was undertaken. Economic status and disease activity were recorded at baseline and following commencement of TNFi therapy. DDAS >1.2 was considered a good clinical response. Descriptive variables are presented as means (Standard Deviation) or percentages.

Results: Employment status of 114 PsA patients was reviewed at a mean of 26 months (22) after starting TNFi therapy. 51% were female, mean age 48 (11) and mean duration of disease of 13 years (8). 50% patients were treated with etanercept, 38% adalimumab, 6% golimumab and 6% infliximab with 46% also receiving DMARD therapy. 2% and 15% continued to take low dose oral steroids and PRN NSAIDs respectively. 79% of patients were judged good clinical responders. 92 patients were in full time employment at baseline.  83/92 (90%) continued in employment with 6 retiring and 3 becoming redundant. Those who retired or became redundant had a higher DAS 28 score at follow up than those who remained in employment (2.4 v 3.2 (ns)). 22 patients were unemployed upon commencing TNFi with 5 of them returning to the workforce. Of those who did not, 14 were on disability benefit prior to starting TNFi, 2 were unemployed and 1 had retired. Only 4% of all patients required home help.

Conclusion: 90% of TNFi treated PsA patients maintain their employed status with 23% of previously unemployed TNFi treated PsA patients returning to the workforce. Cumulatively, 22.8% of our TNFi treated PsA patients are unemployed, an improvement on previous published levels indicating a potential economic benefit of TNFi that may become more apparent in the future. Maintenance of an individual’s work capacity likely results in societal savings that help to offset the substantial cost of TNFi treatment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-of-psoriatic-arthritis-with-tumour-necrosis-factor-a-antagonists-successfully-maintains-work-capacity-2-year-results-of-a-prospective-cohort-study/