Saralynn H. Allaire

The costs of rheumatoid arthritis.

SummaryThe economic costs associated with rheumatoid arthritis (RA). a chronic. systemic. inflammatory disorder that affects many joints. are high. approximating those of coronary heart disease. The estimated prevalence of RA in the US is 0.9%. Incidence increases with age. and is highest among women in the fourth to sixth decades of life, The primary impact of RA is due to the significant morbidity associated with this disease. Mortality is increased among a poorly defined subgroup of RA patients. The average level of disability among RA patients is moderate. but 6.5 to 12% of patients are severely disabled. Between one- and two-thirds of prev iously employed patients have a reduced work capacity.Treatment primarily involves the use of nonsteroidal anti -inflammatory drugs and disease modifying <lntirheumatic drugs. Rehabilitation measures and orthopaedic surgery are also used. Total annual direct costs of RA (total charges) have been calculated to be

Reducing work disability associated with rheumatoid arthritis: Identification of additional risk factors and persons likely to benefit from intervention

US5275 and

Contemporary Prevalence and Incidence of Work Disability Associated With Rheumatoid Arthritis in the US

US6099 ( 1991 dollars) per patient. Lifetime medical care charges were estimated at SUS 12578 per patient (1991 dollars).The dircct costs of RA are substantial, but indirect costS have been calculated to be much higher because of extensive morbidity. The difference between the direct and indirect costs of RA is decreasing because salary increases have nOi kept pace with risin g heahhcare costs. The latter arc increasing rapidly in RA because of the use of new technology. surgical procedures. and the greater use of drugs with frequent monitoring requirements and significant toxicity. Because intangible costs such as pain form a substantial part of the overall costs ofRA but are difficult to evaluate. cost estimates inevitably underestimate the impact of the disease on individuals and society.

Work Disability Resulting From Chronic Health Conditions

OBJECTIVE To study additional risk factors for rheumatoid arthritis (RA)-related work disability and to identify the groups of individuals at high risk and the potentially modifiable factors which place them at risk. METHODS A cross-sectional mail survey was conducted among 469 adults with RA. Work disability was defined as unemployment due to RA. A broad range of explanatory factors was examined, including sociodemographic, health, work, support given by others, and commuting difficulty. Employed and work-disabled subjects were compared by t-test and chi-square. Attributable fractions were calculated to assess the predictive value of factors. A recursive partitioning procedure identified individuals at varying risks for work disability, and their characteristics were defined. RESULTS The risk factors joint pain and functional status, commuting difficulty, physical demands of the job, and disease duration were important predictors of work disability in both the attributable fraction and recursive partitioning analytic models. Having a professional or administrative job was protective, provided the salary earned was not low. Younger individuals with RA of shorter duration were placed at high risk by potentially modifiable factors. While older persons with RA of long duration were at high risk, modifiable factors could not be identified. CONCLUSION Commuting difficulty, a previously overlooked factor, is an important predictor of RA work disability. Younger individuals with RA of relatively short duration can be placed at high risk by potentially modifiable factors including commuting difficulty, physically demanding jobs, greater joint pain and poor functional status, and nonprofessional/non-administrative jobs.

Work Barriers Experienced and Job Accommodations Used by Persons with Arthritis and Other Rheumatic Diseases.

OBJECTIVE To provide a contemporary estimate of the prevalence and incidence of rheumatoid arthritis (RA) work disability and examine its permanence over time. METHODS Data were collected semiannually from 5,384 subjects with rheumatologist-diagnosed RA. We examined prevalence in subgroups formed by approximately 5-year disease duration intervals using data from subjects age < or =64 years who were employed at disease onset. Annual incidence was examined longitudinally among subjects who supplied data in 2003, 2004, or 2005, were employed at disease onset and in a years first survey, and were age < or =63 years. For work disability permanence we used longitudinal data from all subjects who became work disabled and observed whether they later returned to work. RESULTS Mean age of subjects was 52 years, 82% were female, 63% had more than a high school education, mean disease duration was 14 years, and mean Health Assessment Questionnaire score was 1.0. The prevalence of any premature work cessation was 23% in subjects with 1-3 years duration, 35% in those with 10 years, and 51% in those with > or =25 years RA duration. Arthritis-attributed work cessation was 14%, 29%, and 42%, respectively. Annual incidence of any premature work cessation was approximately 10% and arthritis-attributed work cessation incidence was approximately 6%. Thirty-nine percent of subjects who stopped working later returned to work. CONCLUSION Work disability prevalence in this sample was high (35% within 10 years disease duration), but may represent a decline from the 50% prevalence reported in 1987. Annual incidence of work disability was higher than prior studies, but the return to work rate was also higher.

Current Risk Factors for Work Disability Associated With Rheumatoid Arthritis: Recent Data From a US National Cohort

Objectives: To describe current programs and policies for addressing work disability among adults with chronic health conditions, and to identify opportunities for new research aimed at reducing the problem. Methods: The authors conducted secondary data analysis and a literature review. Results: Millions of Americans with a chronic health condition have a work disability or are at risk of developing one. This public health problem is costing hundreds of billions of dollars a year nationally in lost productivity and diminishing the quality of life of millions of Americans. The medical care system, employers, and government—three traditional sources of help for adults with chronic health problems—are not sufficiently oriented toward the primary or secondary prevention of work disability. Conclusions: New research is urgently needed to reduce the burden of work disability on individuals and society.

Decrease in sick leave among patients with rheumatoid arthritis in the first 12 months after start of treatment with tumour necrosis factor antagonists: a population-based controlled cohort study

Many people with arthritis become work disabled, but little is known about (a) the types of work barriers they experience and (b) their use of job accommodations. Our objectives were to describe work barriers and use of accommodations and to examine factors associated with accommodation use in persons with arthritis at risk for work disability. Barrier assessment was conducted using the Work Experience Survey. Factors associated with accommodation use were analyzed by logistic regression. The overwhelming majority of the 121 participants (98%) reported having one or more barriers, and 68% reported 10 or more barriers; 38% used an accommodation. Greater functional limitations and self-efficacy for accommodation request were each associated with accommodation use. Even though these employed persons with arthritis faced multiple barriers at work, only a small number used any form of job accommodation.

Employment and Satisfaction Outcomes From a Job Retention Intervention Delivered to Persons with Chronic Diseases.

OBJECTIVE To explore, using recent data, whether and how risk factors for rheumatoid arthritis (RA) work disability may differ from previous studies. METHODS Subjects were 953 individuals with RA from a US cohort who provided data semiannually over 18 months (years 2002-2005). A nested case-control design was used with matching on time of baseline data collection. All subjects were employed at baseline; cases were consistently not employed at followup, whereas controls remained employed. Hierarchical conditional logistic regression assessed the roles of demographic, RA disease, general health, and work factors as predictors of work disability. Recursive partitioning and causal modeling procedures were also used. RESULTS Sample characteristics were mean age 51 years, 82% female, and 92% white. Older age (odds ratio [OR] 1.2, 95% confidence interval [95% CI] 1.1-1.4) and lower income (OR 1.7, 95% CI 1.0-2.7) predicted work disability, whereas more hours worked (OR 0.9, 95% CI 0.8-0.9) and preference to work full time (OR 0.2, 95% CI 0.1-0.4) or part time (OR 0.4, 95% CI 0.2-0.6) versus not to work were protective in the regression analysis. In recursive partitioning analyses, RA disease factors predicted work disability among older subjects, and functional limitation was the fourth most important factor. Job physical demand was not a significant or important factor. CONCLUSION In this contemporary data from a large RA cohort, older age, lower income, fewer working hours, and preference not to work were the risk factors for work disability. The impact of disease factors was limited to subjects ages >or=56 years. Job physical demand level had little impact.

A Method for Imputing the Impact of Health Problems on At-Work Performance and Productivity From Available Health Data

Objective To investigate the effect of tumour necrosis factor (TNF) antagonist treatment of patients with rheumatoid arthritis (RA) on sick leave (SL) and disability pension (DP) in a population-based setting in southern Sweden. Methods All patients with RA in the South Swedish Arthritis Treatment Group register living in the county of Skåne (population 1.2 million), who started their first treatment with a TNF antagonist between January 2004 and December 2007 and were 18–58 years at treatment start (n=365), were identified. For each patient with RA, four matched reference subjects from the general population were randomly selected. Data were linked to the Swedish Social Insurance Agency register and the point prevalence of SL and DP as well as days of SL and DP per month were calculated from 360 days before until 360 days after treatment start. Results At treatment start 38.6% of the patients with RA were registered for SL. During the first 6 months this share dropped to 28.5% (decrease by 26.2%, p<0.001). This level remained stable throughout the first treatment year. Comparing patients with RA to the reference group the relative risk of being on SL was 6.6 (95% CI 5.2 to 8.5) at initiation of anti-TNF treatment and 5.2 (95% CI 4.0 to 6.8) 1 year after that. The corresponding figures for DP were 3.4 (95% CI 2.7 to 4.2) and 3.2 (95% CI 2.7 to 3.9). Conclusions There was a marked decline in SL during the first 6 months of TNF antagonist treatment in patients with RA in southern Sweden, maintained throughout the first year, which was not offset by a corresponding increase in DP.

Experiencing work as a daily challenge: The case of scleroderma

Job retention services are recommended for people with chronic diseases based on their high risk for work disability. This randomized trial tested the effectiveness of a job retention intervention in a sample of employed persons with rheumatic diseases at risk for work disability. One hundred and twenty-two experimental participants received the job retention intervention, and 120 controls received written materials. Employment status was assessed at 6-month intervals up to 48 months after enrollment. Main outcomes were time to job loss and satisfaction with the experimental and control interventions. The log-rank test was used to detect a difference between the groups in time to job loss. Between-group differences in satisfaction scores were analyzed using Wilcoxon tests. Job loss was delayed in experimental participants compared with controls, p = 0.03. Satisfaction scores for the job retention intervention were substantially higher than those for the written materials, p < 0.0001. Job retention intervention has the potential to reduce the high rates of chronic disease—associated job loss.