Background/Purpose: To evaluate vitality, reduced paid and unpaid work ability, and
productivity losses for patients with early rheumatoid arthritis (RA) available
for work force at baseline and treated with an add-on 6-month induction
infliximab therapy versus a combination of three DMARDs and prednisolone.

Methods: In
the NEO-RACo trial 99 patients with early, DMARD-na•ve RA were treated with a
combination of three DMARDs and prednisolone (FIN-RACo) and randomised to
receive either infliximab (FIN-RACo+IFX) or placebo (FIN-RACo+PLA) infusions
during the first 6 months. The patients were assessed clinically at weeks 0, 4,
6, 10, 14, 18, 22, 26, and at months 8, 10, 12, and thereafter 3-monthly. Patient-reported
SF-36 subscales for vitality (0-100, 100=full vitality) and presenteeism, i.e.,
decreased work productivity while at work (0-100, 100=full presenteeism, i.e.
complete decrease of productivity) were gathered at baseline, and at 8, 12, and
24 months, and the mean values were estimated with an area under the curve
(AUC) approach.

Results: During the 24-month follow-up, vitality
improved significantly in both groups, with no between-group differences.
However, the mean score of presenteeism decreased more from baseline to 8
months in the FIN-RACo+IFX group than in the FIN-RACo+PLA group (-46 vs. -32, p=0.004);
by 24 months the difference between the groups had levelled out (Figure 1). A
negative curvilinear correlation was found between vitality and presenteeism
(Figure 2). A higher body mass index and self-reported depressive symptoms were
associated with lower vitality and higher level of presenteeism (Table 1).

Conclusion : Vitality (antithesis of fatigue) manifests
itself in better work productivity while at work. BMI and depressive symptoms
at baseline were found to be the significant determinants of decreased vitality
and increased presenteeism.

Leirisalo-Repo
et al. Ann Rheum Dis 2013