Work Productivity and Activity Loss in Patients with Newly Diagnosed RA

For individuals with recent-onset rheumatoid arthritis (RA), persistent disease activity was found to impair both work productivity and daily life activities, according to a study presented at the American College of Rheumatology (ACR) Convergence 2021.

The researchers enrolled 673 patients with newly onset RA across Canada. Patients were aged 18 to 64 years, had less than 1 year of symptoms at baseline, and received treatment with disease modifying anti-rheumatic drugs (DMARDs). Patients were followed by rheumatologists between November 2011 and March 2020.

Baseline work status (employed, unemployed, retired) was collected. During the study, participants reported annual work productivity via the Work Productivity and Activity Index (WPAI). Impairment in work productivity is defined as overall WPAI loss with subscores for absenteeism (time away from work) and presenteeism (reduced productivity at work) and reduced general activity. Scores are represented as an impairment percentage, with higher percentages meaning higher impairment and less productivity.

Generalized estimating equations (GEE) were used to calculate associations between WPAI change over the first five years of follow-up after adjusting for age, sex, work commitment (full time; part-time), and comorbidity (Rheumatic Disease Comorbidity Index [RDCI] and depression), and therapy use (methotrexate, biologic DMARDs and JAK inhibitors, or prednisone).

At baseline, 434 participants (65%) were employed, including 352 (82%) who worked full time. Additionally, 159 participants (24%) were unemployed and 74 (11%) were retired. Three-quarters of employed patients were female, 81% were Caucasian, and 68% had some education beyond high school (68%).

Employed patients had baseline mean Disease Activity Score-28 (DAS28) and Modified Health Assessment Questionnaire (mHAQ) scores of 4.7 and 0.5, respectively. The overall average work impairment percentage for employed patients was 39.8%, and 8.4% for absenteeism and 37.0% for presenteeism, specifically. Non-work activity impairment due to health was 43.5% at baseline for employed patients. At one year follow-up, work productivity scores improved but remained stable thereafter.

In lagged multivariable GEE models, higher DAS28 was associated with greater work impairment over time. The mean change over time in overall work impairment was 7.1% (6.2, 7.9), for absenteeism was 1.9%, presenteeism 6.6%, and activity impairment 7.8%. The authors noted that baseline comorbidity was also associated with work impairment over time.

“Patients with early RA report nearly 40% reduced work productivity, mainly from reduced effectiveness while at work, and have similar impairment in non-work activities,” wrote the authors in conclusion. “Interventions to optimize continued engagement in work and addressing difficult to treat RA may improve productivity outcomes for RA patients and their employers.”

Reference: Hitchon C, et al. Persistent Disease Activity Impairs Work Productivity and Non-work Activity in Recent Onset Rheumatoid Arthritis. Arthritis Rheumatol. 2021;73(suppl 10). Presented at ACR Convergence 2021 (Virtual), Nov. 5-9, 2021.