Background/Purpose: Work status and unemployment are significant future concerns among individuals with JIA, because roughly 20% patients enter adulthood with clinically active disease and disabled. Functional impairment allied to work condition may affect one’s physical and mental health with an important impact in social relationships and economic aspects. Therefore we aimed to determine the employment rate and the prevalence of work disability among a cohort of adult patients with JIA from a tertiary rheumatology center and to determine possible associated risk factors.

Methods: Forty-three adult JIA patients according to 2004 revised ILAR criteria were enrolled in this cross-sectional study. Working status and labor activity were assessed through a self-administered questionnaire encompassing educational level, occupation, current/previous work, employment and withdrawal rate. Demographic data, JIA characteristics, clinical activity (DAS28>2.6), functional class (1991 ACR criteria), HAQ and SF-36 scores, therapeutic intervention, comorbidities, physical activity and sedentary status (WHO definitions) were recorded. The prevalence of work disability was calculated using 95% confidence interval, and compared to all parameters; quantitative variables were analyzed using Mann-Whitney or student test and qualitative variables by tests of association (chi-square test).

Results: Mean age of JIA patients was 29+7.4yrs (range 19-41) with mean JIA duration of 17.2+12.3yrs (range 3-33); 63% were males and 37% females. JIA subtypes were: 64% polyarticular (9/27= RF+), 11% oligoarticular, 9% systemic, 9% ERA, 2% extended oligoarticular, 2% psoriatic arthritis. Serum RF was positive in 21%, ANA in 21% and 7% had uveitis. At the time of the study, 72% JIA patients (n=31) were employed whereas 28% (n=12) were not working. In the latter group, 83% (n=10) were prematurely retired due to JIA related disability. Further analysis comparing 31 patients currently working vs. 12 not working revealed similar age (25.3 vs. 29.5yrs, P=0.09), sex ratio, poly onset JIA (22 vs. 6 P=0.37), good education level >12 yrs at school (31 vs. 9, P=0.38), ACR functional class I (P=0.96), practice of regular physical activity (9 vs. 0, P=0.89) and singles (26 vs. 8, P=0.15). Both groups were also comparable for HAQ (0.62 vs. 0.59, P=0.47) and DAS 28 scores (2.51 vs. 2.07, p=0.64) with similar arthroplasty rate (8 vs. 4, p=0.42). Frequencies of hypertension (3 vs. 1, P=0.99), dyslipidemia (1 vs. 1, P=0.12), diabetes (1 vs. 0, P=0.99), depression (1 vs. 0, P=0.99) and smokers (3 vs. 1, P=0.99) were also alike in both groups. Unexpectedly, employed patients had a significantly higher SF 36 mental health component score (84.0 vs. 70.42, P = 0.01).

Conclusion: The present study provides evidence that disease related incapacity remains a matter of concern for adult JIA individuals with a high rate work disability and retirement. Worse mental health in employed patients is intriguing and may indicate that intense affirmative disability actions to remove possible disabling barriers and to adapt to restrictive environments are necessary. Moreover, further attention focused on enhanced strategies and policy for inclusion of JIA patients in the job market is urged.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/worse-mental-health-in-employed-adult-patients-with-juvenile-idiopathic-arthritis-jia-more-than-just-a-job/